In the classical approach to pancreatic lesions, the key used to be to exclude malignancy and evaluate tumor resectability and the patient's suitability for surgery. Pancreatic biopsy was rejected because a negative result does not exclude malignancy, the risk of seeding, which could make curative surgery impossible, the low surgical risk of morbidity and mortality, and the high diagnostic efficacy of imaging techniques. In this context, pancreatic biopsy was limited to irresectable tumors, and cases with suspicion of tuberculosis, lymphoma, neuroendocrine tumors or cystic tumors. Currently, pancreatic biopsy is becoming essential for the correct management of all types of pancreatic lesions, improving therapeutic management. Endoscopic ultrasound-guided biopsy has been proven to be safe, with a low complications rate, and with higher diagnostic efficacy than that of other procedures and is probably the technique of choice for the study of pancreatic lesions.