Endoscopic ultrasound (EUS) is the most sensitive technique for the detection and more importantly for the exclusion of ductal adenocarcinoma of the pancreas. In addition, ultrasound, EUS and sophisticated computed tomography techniques represent nowadays the standard techniques for evaluation of pancreatic disease including staging [J Cancer Res Clin Oncol 2008; 134:635-643. Clin Gastroenterol Hepatol 2008; 6:590-597]. With proof of a definite pancreatic tumour and urgent suspicion of a ductal adenocarcinoma of the pancreas without distant metastasis and option of curative surgery, an operation is primarily indicated. However, this does not mean that each pancreatic mass should unreflected undergo surgery. but the options of the preoperative imaging must be exhausted. In discrepancy to formerly published statements that 95 % of all pancreatic tumours are ductal adenocarcinoma it could be shown that in specialized centers up to 50 % of these masses are other tumour entities. Thus, it is of crucial importance to clarify the dignity of such a mass preoperatively, since a significant operation lethality has to be considered. The quality of the preoperative diagnostics of an interdisciplinary center can also be rated on the basis of preoperative correctly identified diagnoses. This is in particular true for the asymptomatic serous microcystic pancreatic adenoma representing no indication for surgery and autoimmune pancreatitis which should be treated by immunosuppression. In addition, differentiated neuroendocrine tumours should be enucleated preserving pancreatic tissue and should not undergo radical operation technique.