[Autoimmune pancreatitis: An update].

Area of Science:

• Gastroenterology and Immunology
• Diagnostic Imaging
• Oncology

Background:

• Autoimmune pancreatitis (AIP) is a rare pancreatic disease with two main types: type 1 (IgG4-related) and type 2 (associated with inflammatory bowel disease).
• AIP shares clinical overlap with pancreatic cancer, necessitating precise differentiation for optimal treatment.
• Distinguishing AIP from malignancy is crucial to avoid unnecessary pancreatectomies.

Purpose of the Study:

• To highlight the diagnostic challenges and criteria for autoimmune pancreatitis (AIP).
• To emphasize the importance of differentiating AIP from pancreatic cancer.
• To guide clinicians and radiologists in diagnosing AIP accurately.

Main Methods:

• Utilizing consensus criteria from the International Association of Pancreatology, including five cardinal and one therapeutic criterion.
• Employing diagnostic imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).
• Integrating clinical, serological, and histological parameters, with CT/MRI guiding image-assisted biopsies for histology.

Main Results:

• The established criteria for AIP diagnosis demonstrate high accuracy (93.8%), sensitivity (84.9%), and specificity (100%).
• CT and MRI are essential for excluding tumor spread and identifying optimal biopsy sites.
• Histological confirmation often requires sufficient sample material, typically obtained via imaging-assisted biopsy.

Conclusions:

• Autoimmune pancreatitis (AIP) should be considered in patients with unexplained abdominal pain and jaundice, especially when imaging suggests malignancy but clinical signs are inconsistent.
• Radiologists must be aware of clinical, serological, and histological findings to aid in AIP diagnosis.
• Accurate AIP diagnosis facilitates timely initiation of steroid therapy, potentially avoiding aggressive treatments.