Research Article: Serological characteristics of autoimmune pancreatitis and its differential diagnosis from pancreatic cancer by using a combination of carbohydrate antigen 19-9, globulin, eosinophils and hemoglobin

Date Published: April 3, 2017

Publisher: Public Library of Science

Author(s): Tianlian Yan, Yini Ke, Yi Chen, Chengfu Xu, Chaohui Yu, Youming Li, Johannes Haybaeck.

http://doi.org/10.1371/journal.pone.0174735

Abstract

Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis, which may be misdiagnosed as pancreatic carcinoma. This study aims to verify new biomarkers for AIP and propose a serological pattern to differentiate AIP from pancreatic adenocarcinoma with routinely performed tests. In this study, data of serum samples were collected and compared between 25 patients with AIP and 100 patients with pancreatic carcinoma. Receiver operating characteristic analysis and logistic regression was performed to evaluate the diagnostic effect of serum parameters in differentiating AIP from pancreatic carcinoma alone or in combination. Among several serum markers observed in the two groups, carbohydrate antigen 19–9 (Ca19-9), globulin, eosinophils and hemoglobin were selected as the independent markers. Serum levels of Globulin, Eosinophil percentage in AIP group were significantly higher than in pancreatic cancer group (P<0.05), while hemoglobin and tumor marker CA19-9 levels were lower (P <0.05). The combination of these markers identified patients with AIP with 92% sensitivity and 79% specificity, which indicated relatively high diagnostic value. Elevated serum eosinophils, globulin, together with decreased hemoglobin level can be used as a preoperative indicator for AIP and can help to initiate diagnosis of AIP in time.

Partial Text

Since first proposed by Yoshida et al. in 1995 [1], autoimmune pancreatitis (AIP) has gradually become recognized as a unique kind of chronic pancreatitis. Frequently, patients with AIP are characterized clinically by painless obstructive jaundice, histologically by a lymphoplasmacytic infiltration with fibrosis, and therapeutically by a dramatic response to steroids [2, 3]. According to their histopathological differences, AIP is classified into two subtypes [3]. Type 1 AIP is considered to be the pancreatic manifestation of a systemic chronic inflammatory disorder named IgG4-related disease (IRD) [4], whose etiology and pathogenesis remains unclear. In the worldwide, type 1 is more often observed, accounting for 96% of Asian and 80% of European AIP cases [5], whereas type 2 is rare. Consequently, the AIP discussed below is referred to type 1 unless otherwise stated.

In this study, we reported concentration differences of the four serum markers, Ca 19–9, eosinophil percentage, globulin and hemoglobin, in patients with AIP and pancreatic adenocarcinoma. We hope that this research will provide additional evidence to differential diagnosis between the two diseases. Serum levels of globulin, eosinophil percentage in AIP group were significantly higher than those in pancreatic cancer group (p<0.05), while hemoglobin and tumor marker CA19-9 levels were significantly lower (p<0.05). In a single test, none of these serological markers was sufficient for diagnosis. However, the combination of these four could identify AIP with sensitivity of 92% and specificity of 79%, which indicates a relatively high diagnostic value. In this study, we reported serological characteristics of AIP and described a strategy of differential diagnosis at an early phase by using a combination of four serological markers. Elevated serum eosinophil and globulin levels together with decreased hemoglobin level can be used as a preoperative indicator for AIP and can help to avoid unnecessary operation. Multi-center collaboration is needed so as to recruit an adequate sample of subjects and obtain stable and convincing results. Also, the mechanisms of extensive anemia presented in patients with AIP need further investigation, which may implicate the pathogenesis of AIP in a serological aspect.   Source: http://doi.org/10.1371/journal.pone.0174735

 

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