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was increased for cystic lesions and lesions <2 cm. For cystic lesions <2 cm, diagnostic accuracy was increased when CT+MRI+EUS+FNA were used. In the 94 patients with misdiagnosis, surgery was ultimately clinically relevant (MT, PMT or symptomatic BT) in 48 but was inappropriate in 46 (5%). In these 46, multivariate analysis identified age <50 y., familial history of cancer and cystic tumor as risk factors of misdiagnosis. Conclusions: Accurate preoperative diagnosis is presently possible for 89% of PT. Misdiagnosis leads to inappropriate surgery in only 5% of cases. For cystic tumors <2 cm, to increase number of preoperative examinations could increase diagnostic accuracy.