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Research article
Yanying Liu
Peking University People's Hospital Department of Rheumatology and Immunology
Corresponding Author
License:
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Objective
The growing utilization of needle biopsy has challenged the current pathology consensus of IgG4-related disease (IgG4-RD). The aims of this study were to identify the histological characteristics of needle biopsy and surgical specimens, and evaluate the ability of needle biopsy in histological diagnosis of IgG4-RD.
Methods
Biopsies from patients who were referred to as IgG4-RD by the 2019 ACR/EULAR IgG4-RD classification criteria in Peking University People’s Hospital from 2012 to 2019 were re-evaluated. Typical histological features and diagnostic categories were compared between needle biopsy and surgical biopsy.
Results
In total, 69 patients met the 2019 ACR/EULAR classification criteria and 72 biopsies of them were re-evaluated. All cases showed lymphoplasmacytic infiltrate, while storiform fibrosis and obliterative phlebitis were only present in 35 (48.6%) and 23 (31.9%) specimens, respectively. Storiform fibrosis was more likely to be seen in retroperitoneum lesion (P=0.033). Surgical biopsy showed significantly higher IgG4+ plasma cells/high power field (IgG4/HPF) count (P<0.01) and higher proportion of IgG4/HPF>10 (P<0.01). No significant difference was observed with regard to the ratio of IgG4+/IgG+ cells (IgG4/IgG) (P=0.399), storiform fibrosis (P=0.739), and obliterative phletibis (P=0.153). According to the 2011 comprehensive diagnostic criteria, patients who performed a needle biopsy were less likely to be probable IgG4-RD (P=0.045). Based on the 2011 pathology consensus, needle biopsy was tougher to be diagnosed as IgG4-RD (P<0.01), especially to be highly suggestive IgG4-RD (P<0.01). Only 1/18 (5.6%) needle salivary specimens fulfilled the cutoff of IgG4/HPF>100, which was significantly less than 15/23 (65.2%) of surgical ones (P<0.01).
Conclusions
Needle biopsy shows an inferiority in detecting IgG4/HPF count but not in IgG4/IgG ratio, storiform fibrosis and obliterative phlebitis. Compared with surgical samples, it is tougher for needle biopsy to obtain a histological diagnosis of IgG4-RD. A different IgG4/HPF threshold for needle biopsy of salivary glands may be considered.
Keywords
IgG4-related disease, needle biopsy, surgical biopsy, salivary gland, pathology consensus
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CURRENT STATUS: Published
View the published article at Arthritis Research & Therapy.
Version 1
Posted 15 Dec, 2020
No community comments so far
Review #1 received
Received 02 Jan, 2021
Editorial decision: Major revision
On 02 Jan, 2021
Review #2 received
Received 19 Dec, 2020
Reviewer #2 agreed
On 14 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
Reviewers invited
Invitations sent on 09 Dec, 2020
Editor assigned
On 06 Dec, 2020
Submission checks complete
On 06 Dec, 2020
Editor invited
On 06 Dec, 2020
First submitted
On 03 Dec, 2020
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Subject Areas
Rheumatology
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A new preprint design is coming!
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See the published version of this preprint at Arthritis Research & Therapy.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Yanying Liu
Peking University People's Hospital Department of Rheumatology and Immunology
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Arthritis Research & Therapy.
Version 1
Posted 15 Dec, 2020
No community comments so far
Review #1 received
Received 02 Jan, 2021
Editorial decision: Major revision
On 02 Jan, 2021
Review #2 received
Received 19 Dec, 2020
Reviewer #2 agreed
On 14 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
Reviewers invited
Invitations sent on 09 Dec, 2020
Editor assigned
On 06 Dec, 2020
Submission checks complete
On 06 Dec, 2020
Editor invited
On 06 Dec, 2020
First submitted
On 03 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Rheumatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Arthritis Research & Therapy.
Objective
The growing utilization of needle biopsy has challenged the current pathology consensus of IgG4-related disease (IgG4-RD). The aims of this study were to identify the histological characteristics of needle biopsy and surgical specimens, and evaluate the ability of needle biopsy in histological diagnosis of IgG4-RD.
Methods
Biopsies from patients who were referred to as IgG4-RD by the 2019 ACR/EULAR IgG4-RD classification criteria in Peking University People’s Hospital from 2012 to 2019 were re-evaluated. Typical histological features and diagnostic categories were compared between needle biopsy and surgical biopsy.
Results
In total, 69 patients met the 2019 ACR/EULAR classification criteria and 72 biopsies of them were re-evaluated. All cases showed lymphoplasmacytic infiltrate, while storiform fibrosis and obliterative phlebitis were only present in 35 (48.6%) and 23 (31.9%) specimens, respectively. Storiform fibrosis was more likely to be seen in retroperitoneum lesion (P=0.033). Surgical biopsy showed significantly higher IgG4+ plasma cells/high power field (IgG4/HPF) count (P<0.01) and higher proportion of IgG4/HPF>10 (P<0.01). No significant difference was observed with regard to the ratio of IgG4+/IgG+ cells (IgG4/IgG) (P=0.399), storiform fibrosis (P=0.739), and obliterative phletibis (P=0.153). According to the 2011 comprehensive diagnostic criteria, patients who performed a needle biopsy were less likely to be probable IgG4-RD (P=0.045). Based on the 2011 pathology consensus, needle biopsy was tougher to be diagnosed as IgG4-RD (P<0.01), especially to be highly suggestive IgG4-RD (P<0.01). Only 1/18 (5.6%) needle salivary specimens fulfilled the cutoff of IgG4/HPF>100, which was significantly less than 15/23 (65.2%) of surgical ones (P<0.01).
Conclusions
Needle biopsy shows an inferiority in detecting IgG4/HPF count but not in IgG4/IgG ratio, storiform fibrosis and obliterative phlebitis. Compared with surgical samples, it is tougher for needle biopsy to obtain a histological diagnosis of IgG4-RD. A different IgG4/HPF threshold for needle biopsy of salivary glands may be considered.
Figure 1
Figure 1
Figure 2
Figure 2
Figure 3
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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