Clinical Evaluation of the Results of the Secretin Test and of Duodenal Cytology in the Diagnosis of Pancreatic Disease

Abstract

THE early diagnosis of pancreatic disease remains a challenging and perplexing problem. Clinical signs and symptoms may be minimal or misleading in the presence either of inflammatory or of neoplastic disease. The retroperitoneal location of the pancreas renders it almost inaccessible to the usual methods of physical diagnosis, except in instances of large carcinomatous masses and pancreatic cysts. Even at operation, carcinoma of the pancreas may be difficult to diagnose unless there are metastatic nodes. Some surgeons are reluctant to biopsy the pancreas, even with the Vim-Silverman or the Menghini needle, because of the possibility of producing a pancreatic fistula; others believe that needle biopsy is a safe procedure, particularly when it is done transduodenally. However, the findings on needle biopsy may be negative for neoplasm, even when a neoplasm is present. Since pancreatitis may simulate carcinoma, the diagnosis can be proved only by a study of pathologic sections.