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- Title
Establishment of a serum IgG4 cut-off value for the differential diagnosis of IgG4-related sclerosing cholangitis: A Japanese cohort.
- Authors
Ohara, Hirotaka; Nakazawa, Takahiro; Kawa, Shigeyuki; Kamisawa, Terumi; Shimosegawa, Tooru; Uchida, Kazushige; Hirano, Kenji; Nishino, Takayoshi; Hamano, Hideaki; Kanno, Atsushi; Notohara, Kenji; Hasebe, Osamu; Muraki, Takashi; Ishida, Etsuji; Naitoh, Itaru; Okazaki, Kazuichi
- Abstract
Background and Aim IgG4-related sclerosing cholangitis ( IgG4- SC) must be precisely distinguished from primary sclerosing cholangitis and cholangiocarcinoma ( CC) because the treatments are completely different. However, the pathological diagnosis of IgG4- SC is difficult. Therefore, highly specific non-invasive criteria such as serum IgG4 should be established. This study established a cut-off for serum IgG4 to differentiate IgG4- SC from respective controls using serum IgG4 levels measured in Japanese centers. Methods A total of 344 IgG4- SC patients were enrolled in this study. As controls, 245, 110, and 149 patients with pancreatic cancer, primary sclerosing cholangitis, and CC, respectively, were enrolled. IgG4- SC patients were classified into three groups: type 1 (stenosis only in the lower part of the common bile duct), type 2 (stenosis diffusely distributed throughout the intrahepatic and extrahepatic bile ducts), and types 3 and 4 (stenosis in the hilar hepatic region) with 246, 56, and 42 patients, respectively. Serum IgG4 levels were compared, and the cut-offs were established. Results The cut-off obtained from receiver operator characteristic curves showed similar sensitivity and specificity to that of 135 mg/ dL when all IgG4- SC and controls were compared. However, a new cut-off value was established when subgroups of IgG4- SC and controls were compared. A cut-off of 182 mg/ dL can increase the specificity to 96.6% (4.7% increase) for distinguishing types 3 and 4 IgG4- SC from CC. A cut-off of 207 mg/ dL might be useful for completely distinguishing types 3 and 4 IgG4- SC from all CC. Conclusions Serum IgG4 is useful for the differential diagnosis of IgG4- SC and controls.
- Subjects
CHOLANGIOCARCINOMA; DIAGNOSIS; SEROTHERAPY; PANCREATIC cancer; CANCER patients; STENOSIS; RECEIVER operating characteristic curves; THERAPEUTICS
- Publication
Journal of Gastroenterology & Hepatology, 2013, Vol 28, Issue 7, p1247
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/jgh.12248