title: Diagnosing autoimmune pancreatitis with the Unifying-Autoimmune-Pancreatitis-Criteria.
abstract: OBJECTIVE
  We had developed the Unifying-Autoimmune-Pancreatitis-Criteria (U-AIP) to diagnose autoimmune pancreatitis (AiP) within the M-ANNHEIM classification of chronic pancreatitis. In 2011, International-Consensus-Diagnostic-Criteria (ICDC) to diagnose AiP have been published. We had applied the U-AIP long before the ICDC were available. The aims of the study were, first, to describe patients with AiP diagnosed by the U-AIP; second, to compare diagnostic accuracies of the U-AIP and other diagnostic systems; third, to evaluate the clinical applicability of the U-AIP.
  
  
  METHODS
  From 1998 until 2008, we identified patients with AiP using U-AIP, Japanese-, Korean-, Asian-, Mayo-HISORt-, Revised-Mayo-HISORt- and Italian-criteria. We retrospectively verified the diagnosis by ICDC and Revised-Japanese-2011-criteria, compared diagnostic accuracies of all systems and evaluated all criteria in consecutive patients with pancreatitis (2009 until 2010, Pancreas-Outpatient-Clinic-Cohort, n = 84). We retrospectively validated our diagnostic approach in consecutive patients with a pancreatic lesion requiring surgery (Surgical-Cohort, n = 98).
  
  
  RESULTS
  Overall, we identified 21 patients with AiP. Unifying-Autoimmune-Pancreatitis-Criteria and ICDC presented the highest diagnostic accuracies (each 98.8%), highest Youden indices (each 0.95238), and highest proportions of diagnosed patients (each n = 20/21, U-AIP/ICDC vs. other diagnostic systems, p < 0.05, McNemar test). In the Pancreas-Outpatient-Clinic-Cohort, seven patients were diagnosed with AiP (n = 6 by U-AIP, n = 1 by Asian-criteria). International-Consensus-Diagnostic-Criteria confirmed the diagnosis in these individuals. Based on partial fulfillment of U-AIP, AiP was initially suspected in 13% (n = 10/77) of remaining patients from the Pancreas-Outpatient-Clinic-Cohort. In the Surgical-cohort, we identified one patient with AiP by U-AIP and ICDC.
  
  
  CONCLUSIONS
  Unifying-Autoimmune-Pancreatitis-Criteria revealed a satisfactory clinical applicability and offered an additional approach to diagnose AiP.
authors.affiliation: Department of Medicine II, University Medical Centre Mannheim, University of Heidelberg, Germany. Electronic address: alexander.schneider@umm.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Institute of Radiology, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Michaely
authors.affiliation: Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Rückert
authors.affiliation: Department of Medical Statistics, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ströbel
authors.affiliation: Department of Medicine II, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Belle
authors.affiliation: Department of Medicine II, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hirth
authors.affiliation: Department of Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Torsten J
authors.initials: TJ
authors.lastname: Wilhelm
authors.affiliation: Department of Clinical Science, Intervention & Technology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Stephan L
authors.initials: SL
authors.lastname: Haas
authors.affiliation: Department of Medicine II, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Jesenofsky
authors.affiliation: Institute of Radiology, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schönberg
authors.affiliation: Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Marx
authors.affiliation: Department of Medicine II, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Manfred V
authors.initials: MV
authors.lastname: Singer
authors.affiliation: Department of Medicine II, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Matthias P
authors.initials: MP
authors.lastname: Ebert
authors.affiliation: Department of Medicine II, University Medical Centre Mannheim, University of Heidelberg, Germany.
authors.forename: Roland H
authors.initials: RH
authors.lastname: Pfützer
authors.affiliation: Department of Medicine II, University Medical Centre Mannheim, University of Heidelberg, Germany; Department of Clinical Science, Intervention & Technology, Karolinska Institute, Stockholm, Sweden.
authors.forename: J Matthias
authors.initials: JM
authors.lastname: Löhr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis*; D012015:Reference Standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Autoimmune pancreatitis; Chronic pancreatitis; ICDC; IgG4; International consensus diagnostic criteria