- 作者：Evangelos Kalaitzakis?/sup> ; &Dagger ; ; Michael Levy§ ; ; Terumi Kamisawa?/sup> ; Gavin J. Johnson?/sup> ; Todd H. Baron§ ; ; Mark D. Topazian§ ; ; Naoki Takahashi§ ; ; Atsushi Kanno¶ ; ; Kazuichi Okazaki# ; Naoto Egawa?/sup> ; Kazushige Uchida# ; Kashif Sheikh?/sup> ; Zahir Amin?? ; Tooru Shimosegawa¶ ; ; Neomal S. Sandanayake?/sup> ; Nicholas I. Church&Dagger ; &Dagger ; ; Michael H. Chapman?/sup> ; Stephen P. Pereira?/sup> ; Suresh Chari§ ; ; George J.M. Webster?/sup> ; george.webster@uclh.nhs.uk
- 关键词：IgG4-Associated Cholangitis ; Endoscopic Retrograde Cholangiopancreatography ; Immunoglobulin G4 ; Autoimmune Pancreatitis
- 刊名：Clinical Gastroenterology and Hepatology
- 出版年：2011
- 出版时间：September 2011
- 年：2011
- 卷：9
- 期：9
- 页码：800-803.e2
- 全文大小：415 K
Background & Aims
Distinction of immunoglobulin G4¨Cassociated cholangitis (IAC) from primary sclerosing cholangitis (PSC) or cholangiocarcinoma is challenging. We aimed to assess the performance characteristics of endoscopic retrograde cholangiography (ERC) for the diagnosis of IAC.Methods
Seventeen physicians from centers in the United States, Japan, and the United Kingdom, unaware of clinical data, reviewed 40 preselected ERCs of patients with IAC (n = 20), PSC (n = 10), and cholangiocarcinoma (n = 10). The performance characteristics of ERC for IAC diagnosis as well as the ¦Ê statistic for intraobserver and interobserver agreement were calculated.
Results
The overall specificity, sensitivity, and interobserver agreement for the diagnosis of IAC were 88 % , 45 % , and 0.18, respectively. Reviewer origin, specialty, or years of experience had no statistically significant effect on reporting success. The overall intraobserver agreement was fair (0.74). The operating characteristics of different ERC features for the diagnosis of IAC were poor.
Conclusions
Despite high specificity of ERC for diagnosing IAC, sensitivity is poor, suggesting that many patients with IAC may be misdiagnosed with PSC or cholangiocarcinoma. Additional diagnostic strategies are likely to be vital in distinguishing these diseases.