Liver nodules smaller than 25 mm in diameter (19 hepatocellular carcinomas [HCCs] and nine adenomatous hyperplastic nodules [AHNs]) were examined with color Doppler flow imaging and hepatic angiography. Angiography revealed a tumor vessel in eight (42%) of the 19 HCCs, while color Doppler flow imaging revealed an arterial pulsating afferent tumor vessel in 10 (53%) of the 19 HCCs but in none of the AHNs. In addition, color Doppler flow imaging revealed a constant-flow efferent tumor vessel continuing to a portal branch in 10 (53%) of the 19 HCCs but in none of the AHNs. In 15 (79%) of the 19 HCCs, a pulsating afferent tumor vessel or a constant-flow efferent tumor vessel or both were observed. Therefore, in this series, color Doppler flow imaging was of value in distinguishing between these two lesions.

Background. A new clinical type of pancreatic tumor, the mucin‐producing tumor, has been recognized recently. However, it is not always easy to distinguish benign from malignant tumors preoperatively. In this study, three different methods of differentiating mucin‐producing tumors of the pancreas were compared. Methods. Endoscopic ultrasonography, endoscopic retrograde pancreatography, and cytologic examination of pancreatic juice were performed in 14 patients who had mucin‐producing pancreatic tumors (11 carcinomas and 3 adenomas). Pancreatic juice was collected endoscopically without papillotomy. Results. The sensitivity, specificity, and overall accuracy of endoscopic ultrasonography were 82%, 90%, and 79%, respectively; those of endoscopic retrograde pancreatography were 91%, 91%, and 86%; and those of cytologic examination were 91%, 100%, and 93%. Conclusion. Cytologic examination of pancreatic juice was the best of these three methods for differentiating benign from malignant mucin‐producing pancreatic tumors.

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Background. The early diagnosis of pancreatic carcinoma through the use of traditional radiographic or ultrasonographic methods is extremely difficult. Methods. To detect an early and potentially curable cancer of the pancreas, endoscopic retrograde pancreatography (ERP) and aspiration cytology of pure pancreatic juice were performed in 295 consecutive patients who had symptoms or findings that suggested pancreatic disease but in whom there was neither a pancreatic mass nor ductal stenosis. Results. Positive cytologic results were obtained in 12 patients (4%). With the aid of intraoperative cytodiagnosis, all 12 early neoplasms of the pancreas were successfully resected. Of these 12 resected specimens, 4 were adenocarcinoma with minimal invasion, 3 were in situ adenocarcinoma and 5 were marked atypia. All 12 patients were alive with no evidence of recurrence for an average of 32 months after surgery. The 283 patients who had negative ERP‐cytology results were observed, but no further cases of pancreatic cancer were found. Conclusions. Because ERP‐cytology is simple to perform, safe, and reliable, it is useful in the diagnosis of patients who have early neoplasm of the pancreas.

The diagnostic accuracy of routine abdominal sonography for the detection of pancreatic cancer was examined. During the one-year period of 1994, sonographic examination of the upper abdominal region was performed 12,761 times on a total of 9410 patients for the screening of abdominal disorders. In 655 cases (7%) part of the pancreas could not be observed. Based on the "Diagnostic criteria for pancreatic cancer" published by the Japanese Society of Ultrasound in Medicine, sonographic finding was evaluated to be positive for pancreatic tumor in a total of 411 cases. At the end of 1995, 51 patients were proven to have pancreatic cancer, and 45 of these cases were ductal adenocarcinoma. In 26 cases the tumor was surgically resected. Fifty cases were true sonographic positives and one was a false negative. The sensitivity, specificity, overall accuracy, and positive and negative predictive values of sonography for pancreatic cancer were 98.0%, 95.9%, 95.9%, 12.2% and 100.0%, respectively. Among the 50 true positive cases, the tumor diameter was less than 1 cm in four (8%). In conclusion, the diagnostic accuracy of sonography for the detection of pancreatic cancer is sufficiently high. Therefore, a detailed study aimed at mass screening for pancreatic cancer using sonography as the main modality seems warranted as a countermeasure for the rapid increase of pancreatic cancer in Japan.