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.