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Usefulness of endoscopic biopsy using FOXP3 + Treg up‐regulation in the duodenal papilla in the differential diagnosis between autoimmune pancreatitis and pancreatic cancer
Author(s) -
Kubota Kensuke,
Kato Shingo,
Watanabe Seitaro,
Fujita Koji,
Yoneda Masato,
Takahashi Hirokazu,
Inamori Masahiko,
Shimamura Takeshi,
Kirikoshi Hiroyuki,
Kobayashi Noritoshi,
Saito Satoru,
Hisatomi Kantaro,
Matsuhashi Nobuyuki,
Nakajima Atsushi
Publication year - 2011
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-010-0359-0
Subject(s) - major duodenal papilla , foxp3 , autoimmune pancreatitis , pancreatic cancer , medicine , receiver operating characteristic , pancreatitis , gastroenterology , differential diagnosis , biopsy , pathology , endocrinology , cancer , immune system , immunology
Background and study aims Expression of the forkhead/winged helix family of transcription factor P3+ regulatory T cells (FOXP3 + Treg), a master gene of regulatory T cells (Treg) is observed in patients with autoimmune pancreatitis (AIP). We investigated the usefulness of detection of FOXP3 + Treg in the main duodenal papilla for differential diagnosis between AIP and pancreatic cancer (Pca). Patients and methods Firstly, we determined the cut‐off value of FOXP3 expression in duodenal papilla taken from the patients with AIP ( n = 22) and chronic pancreatitis ( n = 21). Data from 32 patients with AIP and 30 patients with Pca who had undergone endoscopic biopsy were then studied. The numbers of FOXP3 + Treg‐positive lymphocytes and IgG4‐positive plasma cells per high‐power field (HPF) were counted in all the histopathological specimens. Results The areas under the receiver‐operating characteristic (AUROC) curves for FOXP3 + and IgG4 expression were 0.934 and 0.953, respectively. Cut‐off values calculated based on AUROC data were 14/HPF in FOXP3 and 10/HPF in IgG4. Seropositivity for IgG4 was observed in 22 out of the 31 patients with AIP (sensitivity 71.0%, specificity 84.6%, accuracy 75.0%). Significant infiltration of the major duodenal papilla by FOXP3 + lymphocytes (≥14/HPF) was recognized in 18 of the 32 patients with AIP (sensitivity 56.3%, specificity 100%, accuracy 77.4%). Significant infiltration of the major duodenal papilla by IgG4‐positive plasma cells (≥10/HPF) was recognized in 27 of the 32 patients with AIP (sensitivity 84.4%, specificity 80.0%, accuracy 82.3%). Conclusions Observation of FOXP3 + cells in the main duodenal papilla may be useful in the differential diagnosis between AIP and Pca.