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Serum Immunoglobulin G4 in Discriminating Autoimmune Pancreatitis From Pancreatic Cancer

A Diagnostic Meta-analysis

Dai, Cong PhD; Cao, Qin MD; Jiang, Min PhD; Sun, Ming-Jun PhD

doi: 10.1097/MPA.0000000000000994
Original Articles
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Objective Differentiation between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) is a clinical challenge. Emerging published data on the accuracy of serum immunoglobulin G4 (IgG4) for the differential diagnosis between AIP and PC are inconsistent. The objective of our study was to perform a meta-analysis evaluating the clinical utility of serum IgG4 in the differential diagnosis between AIP and PC.

Methods We performed a systematic literature search of multiple electronic databases. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. Random-effects model was used to summarize the diagnostic odds ratio and other measures of accuracy.

Results Eleven studies comprising 523 AIP patients and 771 PC patients were included in the meta-analysis. The summary estimates for serum IgG4 in distinguishing AIP from PC were as follows: diagnostic odds ratio, 57.30 (95% confidence interval [CI], 23.17–141.67); sensitivity, 0.72 (95% CI, 0.68–0.76); specificity, 0.93 (95% CI, 0.91–0.94). The area under the curve of serum IgG4 in distinguishing AIP from PC was 0.9200.

Conclusions Our meta-analysis found that serum IgG4 has high specificity and relatively low sensitivity in the differential diagnosis between AIP and PC. Therefore, serum IgG4 is useful in distinguishing AIP from PC.

From the Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.

Received for publication May 16, 2017; accepted December 15, 2017.

Address correspondence to: Cong Dai, PhD, Department of Gastroenterology, First Affiliated Hospital, China Medical University, No. 92 of Beier Road, Heping District, Shenyang, Liaoning, 110001 China (e-mail: congdai2006@sohu.com).

This research was supported by the National Natural Science Foundation of China (no. 81300273) and the Natural Science Foundation of Liaoning Province (no. 20170541052).

C.D. and M.J. carried out the literature search, selection, validity assessment, data abstraction, and data analysis. C.D., Q.C., and M.J. wrote the paper and incorporated the comments from other authors and peer reviewers. C.D. and M.-J.S. had the original idea for the paper, formulated the protocol, and contributed to data abstraction and analysis. All authors reviewed and approved the final draft of the paper.

The authors declare no conflict of interest.

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