Limitations of EUS in diagnosing CP

What are the limitations of EUS in diagnosing CP? 

Interobserver agreement for the diagnosis of CP is moderate with kappa of 0.45; for the individual EUS features of CP, there is poor to moderate agreement, with the highest agreement for ductal dilation and lobularity. 

Determination of whether EUS findings are pathologic or represent asymptomatic fibrosis, normal age-related changes, or normal variant is not possible. Asymptomatic EUS changes of CP have been reported in alcoholics, patients of advanced age, and patients who smoke without clinical CP.

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