OBJECTIVES: To assess patient outcomes of various strategies for determining diagnosis and resectability in patients with suspected pancreatic cancer (PC). METHODS: We used data from a prospective study of 193 patients with suspected PC performed at the Charité University Hospital from August, 1999 - November, 2000. These patients underwent each of the following six different diagnostic procedures: ultrasound (US), magnetic resonance imaging (MR), computed tomography (CT), endoscopic ultrasound (EUS), fluorodeoxyglucose positron emissiontomography (PET), and endoscopic retrograde cholangiopancreaticography (ERCP). We developed a decision tree to predict diagnostic accuracy and resectability using the conditional probabilities derived from our study. In the first step, we sought to maximize the number of patients having both diagnostic and resectability state correctly classified. As the varying types of incorrect assessments lead to different clinical consequences, we determined a clinical consequence score to assess the impact of these consequences on mortality and quality of life (e.g. inadequate treatment following an imperfect classification). This score ranged from 100 (best scenario, benign diagnosed as benign) to 0 (worst scenario, benign and unresectable classified as resectable). Each possible scenario’s score was estimated by a clinical panel of experts. In the second step, these score values were incorporated into the decision tree as patient outcome weights. RESULTS: Regarding correct classification, best test performance was achieved with MR alone, correctly classifying 79% of patients as benign, malignant/resectable, or malignant/unresectable. The combination of PET and EUS had the worst performance with only 61% of patients correctly classified. The incorporation of the clinical consequence score lead only to minor differences between the strategies. Probabilistic sensitivity analysis showed robust results in both portions of the study. CONCLUSIONS: The incorporation of the clinical consequence score failed to determine a superior strategy. Once quality-adjusted life years and costs are estimated, we will perform a cost-effectiveness analysis.