The 2023 revised diagnostic criteria for IgG4-related dacryoadenitis and sialadenitis.

OBJECTIVES

For the diagnosis of immunoglobulin G4 (IgG4)-related dacryoadenitis and sialadenitis, either revised comprehensive diagnostic criteria or organ-specific diagnostic criteria for IgG4-related dacryoadenitis and sialadenitis in 2008 were applied; however, the collected knowledge for IgG4-related dacryoadenitis and sialadenitis required us to revise the criteria for IgG4-related dacryoadenitis and sialadenitis.

METHODS

The board member of Japanese Study Group for IgG4-related Dacryoadenitis and Sialadenitis revised the diagnostic criteria for IgG4-related dacryoadenitis and sialadenitis. We collected the clinical questions to be revised and performed a review of the literature. When the data were insufficient, additional data collection was performed. After the revision, public comments were collected.

RESULTS

The three major points were revised. (1) Asymmetric or under two pairs of dacryoadenitis and sialadenitis were included as IgG4-related dacryoadenitis and sialadenitis. (2) The thresholds of IgG4-positive cell infiltration were adjusted to an IgG4+/IgG+ ratio >0.4 and IgG4+ cells >10 per high power field. (3) The labial salivary gland biopsy was allowed to diagnose IgG4-related dacryoadenitis and sialadenitis.

CONCLUSIONS

The revised diagnostic criteria for IgG4-related dacryoadenitis and sialadenitis solved several issues with the previous criteria. It will improve the early diagnosis of IgG4-related dacryoadenitis and sialadenitis, especially in situations without enough resources for a biopsy.