The results of pancreatography during pancreatic carcinogenesis.

Systematic histologic-pancreatographic examination of the pancreas during pancreatic ductal carcinogenesis revealed both specific and nonspecific diagnostic criteria. Ductal changes due to hyperplasia of ductal epithelium were recognized as distention rather than narrowing. This condition, however, occurred in limited numbers during advanced ductal alteration and was found to be an insignificant criterion. The most reliable tumor marker was complete ductal obstruction: ductal deterioration (displacement, deformity) occurred in 63% of the tumor cases, a pooling effect occurred in 44%, and a filling defect occurred in 42%. In both histologic and pancreatographic studies was found the "chain of lakes" caused by ductular proliferation or adenomas both of which seem to represent precursor stages of adenocarcinomas. Some neoplasms escaped diagnosis, due to either their small size, anatomic location, or specific histologic patterns. The data indicated that pancreatography per se as an early detection tool is unreliable.