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Establishment of a serum IgG 4 cut‐off value for the differential diagnosis of IgG 4‐related sclerosing cholangitis: A J apanese cohort
Author(s) -
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
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12248
Subject(s) - medicine , primary sclerosing cholangitis , gastroenterology , receiver operating characteristic , bile duct , differential diagnosis , pathological , intrahepatic cholangiocarcinoma , pancreatic cancer , pathology , cancer , disease
Background and Aim IgG 4‐related sclerosing cholangitis ( IgG 4‐ SC ) must be precisely distinguished from primary sclerosing cholangitis and cholangiocarcinoma ( CC ) because the treatments are completely different. However, the pathological diagnosis of IgG 4‐ SC is difficult. Therefore, highly specific non‐invasive criteria such as serum IgG 4 should be established. This study established a cut‐off for serum IgG 4 to differentiate IgG 4‐ SC from respective controls using serum IgG 4 levels measured in J apanese centers. Methods A total of 344 IgG 4‐ 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. IgG 4‐ 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 IgG 4 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 IgG 4‐ SC and controls were compared. However, a new cut‐off value was established when subgroups of IgG 4‐ 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 IgG 4‐ SC from CC . A cut‐off of 207 mg/ dL might be useful for completely distinguishing types 3 and 4 IgG 4‐ SC from all CC . Conclusions Serum IgG 4 is useful for the differential diagnosis of IgG 4‐ SC and controls.