Transcutaneous fine-needle aspiration (FNA) biopsies were performed on 30 patients with space-occupying lesions in the pancreas. Patient selection for FNA was based on pancreatic lesions suspected of malignancy by clinical and/or radiologic imaging methods. Patients with obstructive jaundice were excluded because of the necessity of laparotomy to relieve biliary obstruction. Of these 30 cases, 15 cases were positive for malignant cells. Of these 15 positive cases, 11 were adenocarcinomas of duct cell origin, one cystadenocarcinoma, one islet cell tumor, one lymphoma, and one metastatic malignant melanoma. The remaining 15 cases, negative for malignant cells, were ultimately shown to have the following lesions: five adenocarcinomas of the pancreas, one metastatic carcinoma from the breast, and nine nonneoplastic disease. Overall diagnostic accuracy was 80%. The sensitivity, specificity, and predictivity for positive FNA biopsy of pancreatic malignancy were 79, 100, and 100%, respectively. Cytologic features with corresponding histologic types were presented. Immunocytochemical and electron microscopic studies were performed on some cases. Only one complication that was possibly related to FNA biopsy occurred. In conclusion, transcutaneous FNA biopsy of pancreatic malignancy is highly valuable in patient management.