Differentiating pancreatic cancer from pseudotumorous chronic pancreatitis.

The differentiation between pancreatic carcinoma and pseudotumorous pancreatitis continues to be a challenge. Several diagnostic imaging and endoscopic modalities can assist in making the differentiation, but the accuracy of each method varies. Radiologic imaging techniques include transabdominal ultrasound, computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, and positron emission tomography. Endoscopic techniques include endoscopic ultrasonography, intraductal ultrasonography, and endoscopic retrograde cholangiopancreatography with brush cytology of pancreatobiliary strictures, endoscopic forceps biopsy, and analysis of pancreatic juices for malignant cells. Tumor markers appear to be promising, but further studies are needed to define the role of these markers.