Abstract
This report compares pathological and clinical findings in pancreatic carcinoma and assesses diagnostic modalities for this condition in order to provide a data base for their rational use especially in the diagnosis of small resectable tumors.
One hundred and twenty-two patients with proven pancreatic carcinoma have been studied during the period between 1972 and 1982. Angiographic findings in pancreatic carcinoma were pathologically analyzed. The radiographic appearance of arterial encasement reflects arterial narrowing due to fibrosis from the presence of malignant cells around the vessel wall, with intimal proliferation as a secondary response producing additional narrowing and irregularity of the lumen. In arterial occlusion, the lumen is still patent, but is considerably narrowed with intimal proliferation secondary to the gross reduction in caliber of the vessel. Comparative study of macroscopic and angiographic findings revealed that angiography accurately defines tumor size. Invasion of carcinoma into the surrounding tissue can also be diagnosed with angiography. However, pancreatic capsule invasion was difficult to assess.
A prospective comparison of sensitivity, specificity and predictive value of ultrasonography (US), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP) and angiography was performed. ERCP had the highest sensitivity and specificity in evaluation of pancreatic carcinoma. CT was the least sensitive in detecting pancreatic malignancy. Positive predictive value was the highest in angiography, while negative predictive value was high in US and ERCP. A diagnosis of unresectable pancreatic carcinoma could be made by US and CT without need for additional imaging procedures. ERCP can show very small tumors, even when the size of the gland is normal. Angiography is a complementary examination to ERCP to determine whether the lesion is benign or malignant, and, if malignant, whether it is resectable or not.
