The prepyloric suspect lesion.

Abstract

There is a difference of opinion among radiologists as to what constitutes a satisfactory x-ray report. Some make it a practice to describe in detail the physical routine used in completing the roentgen examination and give a long description of the findings. The other extreme is a report limited to a diagnosis, while in between are all of the variations which could be anticipated. It is quite possible that either extreme could be useful under certain circumstances, though special emphasis should be given to the fact that the referring physician has sent the patient for a consultation and is not interested in the way in which the x-ray tools are used or in the manner in which the radiologist reaches an opinion. He is interested in a diagnosis, or a differential opinion if a diagnosis cannot be given, and should appreciate greatly any help as to the accepted method or manner of handling the case if it is a difficult or complicated one and comes within a grouping in which the radiologist is particularly skilled or has special knowledge or interest. Under these circumstances, the consultation is most rewarding to the referring physician, who is thereby able to expedite the necessary procedures to establish a diagnosis and hasten the patient's recovery. This type of practice of radiology finds one of its greatest opportunities in studies of the intestinal tract, and particularly in dealing with prepyloric suspect lesions. The accuracy of roentgen diagnosis of gastrointestinal tract lesions is so well known and so widely accepted that the radiologist is usually given the opportunity, early or late, to examine most patients who have symptoms suggesting digestive disease. To be effective in its results the x-ray study requires great skill, and the lesion in the stomach must be of sufficient magnitude to produce recognizable abnormalities on the screen and films of diagnostic significance. The source of patients with gastrointestinal-tract symptoms seen by the radiologist is significant, in that a high percentage are referred by men who are not gastroenterologic internists or physicians especially skilled in the treatment of digestive disease. When the x-ray diagnosis is a prepyloric suspect lesion, the responsibility of the radiologist increases greatly because of the necessity of emphasizing the potential seriousness of the condition to the general physician and suggesting an appropriate procedural program and follow-up regime. As used in this paper, the term prepyloric suspect lesion, i.e., carcinoma suspect, designates a persistent deformity in the contour or an aberration in the mucosal pattern of this portion of the stomach of such character as to make an unqualified x-ray diagnosis impossible. It would thus include both additive (ulcer) and subtractive (infiltrative) lesions, and a combination of the two, as well as extragastric deforming processes.