OBJECTIVE: This aim of this study is to investigate the diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic lesions. PATIENTS AND METHODS: Patients with pancreatic lesions after CT (or MRI) and EUS-FNA examination were retrospectively enrolled. Cytopathological diagnosis of pancreas tissue were obtained by surgery or EUS-FNA. Clinical follow-up results were used as golden standard for diagnosis of pancreatic lesions. Statistical analysis was performed by Student's t-test for continuous data and Fischer exact test for categorical data. RESULTS: A total of 18 patients with pancreatic lesions were included in this study, 7 of which were diagnosed as benign lesions and 11 were diagnosed as malignant lesions. Endoscopic ultrasonography (ESU) showed that most of the lesions were in pancreatic body (42.9%), followed by pancreatic head, pancreatic tail, and pancreatic neck. The maximum diameter of malignant lesions was larger compared with that of benign and the difference was statistically significant (p < 0.05). The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EUS-FNA for differentiating diagnosis of malignant and benign pancreatic lesions was 83.3%, 80%, 83.3%, 90.9%, and 71.4%, respectively. CONCLUSIONS: EUS-FNA cytological diagnosis is safe and effective for differentiating diagnosis of malignant and benign pancreatic lesions.