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7 Furukawa T, Tsukamoto Y, Naitoh Y, Hirooka Y, Hayakawa T: Differential diagnosis between benign and malignant localized stenosis of the main pancreatic duct by intraductal ultrasound of the pancreas. Am J Gastroenterol 1994;89: 2038–2041. 8 Wiersema MJ, Kochman ML, Cramer HM, Tao LC, Wiersema LM: Endosonographyguided real-time fine-needle aspiration biopsy. Gastrointest Endosc 1994;40:700–707. 9 Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM: Endosonographyguided fine-needle aspiration biopsy: Diagnostic accuracy and complication assessment.

However, for potentially resectable cancers immediate histological or cytological confirmation of malignancy is unnecessary. Helical CT is an advance over standard CT in its ability to detect and stage pancreatic cancer. The major advantage of helical CT over standard EUS technique is related to a more accurate detection of tumor involvement of the superior mesenteric artery. Even more than 20 years after the introduction of EUS into the clinical workup of patients with pancreatic mass lesions, EUS and additional methods are still not able to reliably distinguish between inflammatory and malignant masses in some cases.

Acta Radiologica 1997;38: 101–112. 32 Kim AY, Choi BI, Kim TK, Kim KW, Lee JY, Han JK: Comparison of contrast-enhanced fundamental imaging, second-harmonic imaging, and pulse-inversion harmonic imaging. Invest Radiol 2001;36:582–588. 33 Rösch T, Lightdale CJ, Botet JF, et al: Localisation of pancreatic endocrine tumours by endoscopic ultrasonography. N Engl J Med 1992; 326:1721–1726. 34 Hirota T, Tomida T, Iwasa M, Takahashi K, Kaneda M, Tamaki H: Solitary pancreatic metastasis occurring eight years after nephrectomy for renal cell carcinoma: A case report and review of the literature.

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