Pancreatic, ductal, and Vaterian neoplasms: their roentgen manifestation.

Abstract

The surgical treatment of tumors in the head of the pancreas, ampulla of Vater, and periampullary region has improved remarkably during the past decade. With this improvement has come new hope for patients with operable tumors in this region. It is essential, therefore, that radiologists familiarize themselves with the early roentgen manifestations of these neoplasms. To recognize them when they are large and seen with ease is not enough. Nor will it suffice to wait for jaundice before turning attention to this part of the upper intestinal tract. The best interest of the patient will be served only when radiologists develop a high index of suspicion with respect to these neoplasms. That this may lead to “over-reading” of roentgenograms and errors favoring disease when none actually exists is possible; that is the chance that must be taken if earlier diagnosis is to be encouraged. Before subjecting patients to exploration, all radiologic cunning and acumen must be exhausted. In early lesions even the surgeon often has difficulty in making the diagnosis at operation, and the most meticulous inspection and examination are required. Biopsy in this region being hazardous, it is essential that the radiologist be reasonably certain or have very strong suspicions that the patient harbors the disease before making a diagnosis of a pancreatic tumor. Being convinced that we were overlooking too many pancreatico-ampullary lesions, we decided to reinvestigate this entire problem. The records of everyone with a growth in the pancreaticoduodenal region including vaterian and common-duct neoplasms were reviewed. In all, the records of 105 patients were studied. In about one-half, the roentgenograms were available for study. Since carcinoma of the head of the pancreas, carcinoma of the ampulla and the papilla of Vater, and carcinoma of the common duct occasionally may not be differentiated from one another grossly or histopathologically, the data, herein presented, are subject to that error. To summarize briefly, we failed to recognize about half of the tumors in this region, even though all were carefully studied with barium and some with air according to the technic of Engel and Lysholm (12). Beeler and Kirklin (1) reported a somewhat parallel experience. In only 50 of 108 patients with cancer in the head of the pancreas was the correct diagnosis made by radiologic studies. The remaining 58 examinations were considered negative. Having completed the survey, we again studied the roentgenograms originally misinterpreted. In almost every instance, the correct diagnosis could have been made from the original studies. The purpose of the present report is to summarize the roentgen manifestations of carcinomatous lesions in the head of the pancreas, the ampulla and papilla of Vater, and the common duct. We regret that we have nothing new to report.