Evaluation and follow-up of pancreatic arteriograms. A new role for angiography in the diagnosis of carcinoma of the pancreas.

Of over 300 pancreatic arteriograms done in this hospital group adequate follow-up was possible in only 103 patients, with carcinoma in 35 of them. Based on the prospective report there were three false negatives and seven false positive carcinoma diagnoses, an overall accuracy rate of 90.3%. A retrospective review could eliminate all but one false negative and one false positive diagnosis. Angiographic findings are reviewed separately for periampullary and truely pancreatic carcinoma. Subselective catheterisation and adequate opacification of the arterial network of the pancreas allows the reliable demonstration or exclusion of even 1--2 cm carcinomas, provided the clinical presentation of the patient has not been that of jaundice or pancreatitis. Taking into account the availability of newer non-invasive imaging techniques, clinical situations are listed in which the angiographic diagnosis of carcinoma is no longer required. The new purpose of angiography in pancreas carcinoma diagnosis is the demonstration of small and still curable lesions, the prerequisite for this being a much earlier clinical suspicion of the disease and an earlier referral for angiography.