As the mortality rate of pancreatic resection has steadily decreased, the reluctance of surgeons to proceed to operation without histological confirmation of pancreatic cancer has tended to disappear.The negative predictive value is variable and not high enough for the certain exclusion of malignancy. Therefore in the presence of a potentially resectable lesion which is highly suspicious of malignancy the clinician should consider operation even if preoperative histology or cytology is negative.

In the present scenario EUS guided pancreatic biopsy is ideal.However clinical,serological and radiological parameters are suggestive with negative or equivocal histopathology,one can go ahead with surgery after explaning the patient.Eventhough mortality and morbidity in high volume centres has become low but it still it is there.

@Alawad and @Reddy: would you please produce references (previous study) suggesting surgery without tissue diagnosis?