Pancreatogram Findings for Carcinoma in situ (CIS) of the Pancreas Seen on Endoscopic Retrograde Cholangiopancreatography and Postoperative Pancreatography of Resected Specimens: Can CIS Be Diagnosed Preoperatively?

Background/Aims: From 1992 to 2003, 7 carcinomata in situ (CIS) were incidentally discovered during microscopical observation of resected materials for advanced carcinomas of peripancreatic organs, of which 4 had undergone endoscopie retrograde cholangiopancreatography (ERCP) or postoperative pancreatography of the resected specimen (POP). In addition, 7 of 79 invasive ductal carcinomata (IDC) of the pancreas were accompanied by CIS ≥ 2 cm long. A total of 11 patients were reviewed here for pancreatographic findings for CIS of the pancreas. Methods: All resected pancreatobiliary materials were sliced serially at 5-to 8-mm intervals in a plane at right angles to the main pancreatic duct, referring to POP images. Results: Irregularity (I), non-continuous narrowing (N), granular defects (G), and dilatation (D) were seen in 78, 67, 33 and 22% on ERCP, respectively, and in 90, 70, 60 and 40% on POP, respectively. Conclusions:I, N, G,and D are most important pancreatographic findings in ERCP and highly suggestive of CIS of the pancreas, so that whenever they are encountered, cytological and/or pathological examination of the pancreatic duct should be actively performed.