EUS-guided FNA made the correct diagnosis in 43 out of 46 lesions for which the specimen was adequate (accuracy of 93%). EUS-guided FNA avoided surgery in 12 out of 44 (27%) patients and may have avoided surgery in an additional 6 out of 44 (14%). In 25 out of 44 (57%) patients, EUS-guided FNA made a tissue diagnosis of malignancy, which avoided the need for subsequent imaging tests. For all lesions (pancreatic lesions and lymph nodes) and all specimens, the sensitivity of EUS-guided FNA was 83%, the specificity 82%, the diagnostic accuracy 88%, the negative predictive value 82% and the positive predictive value 100%. There was one complication (2%): a patient with a pancreatic mass and an adjacent pancreatic cyst had EUS-guided FNA of both lesions and developed a fever of 102 degrees Fahrenheit 3 days after the procedure. The patient was treated with intravenous antibiotics and was discharged after 2 days.