EARLY DIAGNOSIS OF PANCREATIC-CARCINOMA - REALITY OR OXYMORON

The greatest impact on survival in pancreatic carcinoma will most likely be from earlier diagnosis. Newer technologies have surfaced and dramatic improvements in existing diagnostic techniques have occurred in detecting smaller tumors. Fast spiral CT scans utilizing dynamic intravenous contrast have resulted in very high resolution of small masses while improving accuracy of vascular staging. Improved cytology brushes and biopsy forceps during ERCP should improve the preoperative diagnosis of malignancy. Endoscopic ultrasound similarly is proving very useful for detecting small lesions, depth of invasion, and vascular involvement. Specialized use, lengthy training, and cost may limit its dissemination though. Also remarkable has been vastly improved MR images with 3-D reconstruction (Magnetic Resonance Cholangiopancreatography). Randomized controlled trials comparing these improved and new techniques are awaited. (C) 1995 Wiley-Liss, Inc.