ArticleJHEP reports : innovation in hepatology2020
IgG4/IgG RNA ratio does not accurately discriminate IgG4-related disease from pancreatobiliary cancer.
Article in JHEP reports : innovation in hepatology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- European Guideline on IgG4-related digestive disease - UEG and SGF evidence-based recommendations.United European gastroenterology journal · 2020Guideline
- Identification of candidate biomarkers for diagnosis, disease activity, and relapse prediction in IgG4-related disease.Arthritis research & therapy · 2026Article
- IgG4-Related Cholangitis.Seminars in liver disease · 2025Review
- Article
- The Clinical Utility of Soluble Serum Biomarkers in Autoimmune Pancreatitis: A Systematic Review.Biomedicines · 2022Review
- IgG4-related diseases of the digestive tract.Nature reviews. Gastroenterology & hepatology · 2022Review
- Serum IgG4 levels outperform IgG4/IgG RNA ratio in differential diagnosis of IgG4-related disease.JHEP reports : innovation in hepatology · 2020Article
- Quality and reproducibility during the COVID-19 pandemic.JHEP reports : innovation in hepatology · 2020Article
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND &
aimsIgG4-related disease (IgG4-RD) of the biliary tract and pancreas is often difficult to distinguish from pancreatobiliary cancer. The blood IgG4/IgG RNA ratio has been reported to discriminate IgG4-RD from primary sclerosing cholangitis/pancreatobiliary cancer with high accuracy. This study aimed to prospectively assess the diagnostic accuracy of the blood IgG4/IgG RNA ratio for distinguishing IgG4-RD from cancer in patients with a suspected pancreatobiliary malignancy.
methodsIn this prospective, single center, observational study, patients presenting at a specialized multidisciplinary, hepato-pancreato-biliary clinic with suspicion of pancreatobiliary malignancy were included. The IgG4/IgG RNA ratio (threshold 5.0%) was determined by quantitative PCR in addition to standard diagnostic procedures. Clinical, biochemical, radiological, and histo-/cytopathological findings were analyzed. For the diagnosis of IgG4-RD, the HISORt criteria were used as a reference standard. Malignancy was defined by the presence of neoplastic tissue at histo-/cytopathological examination.
resultsOverall, 213 consecutive patients (mean age 68 years) with a suspected pancreatobiliary malignancy were analyzed, of whom 3 patients were diagnosed with IgG4-RD and 178 patients were diagnosed with malignancy (165 patients with primary pancreatobiliary malignancy). The IgG4/IgG RNA ratio was true positive in 3 patients and false positive in 87 (40.8%) patients. In 123 (57.7%) patients the test was true negative. The sensitivity of blood IgG4/IgG RNA ratio was 100%, the specificity 58.6%, the positive predictive value 3.3%.
conclusionIn the setting of a high LAY SUMMARY: IgG4-related disease is a benign inflammatory multiorgan disease which predominantly affects the pancreas and biliary tree. Clinical symptoms, laboratory and imaging finding are often difficult to distinguish from pancreatic or biliary tract cancer. This prospective trial indicates that the recently proposed blood IgG4/IgG RNA ratio does not accurately distinguish benign IgG4-RD from malignant pancreatobiliary disease.
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