Fine needle aspiration (FNA) cytology, together with imaging, has become a primary diagnostic modality for investigation of pancreatic mass lesions, both cystic and solid. Advances in imaging techniques have enhanced our ability to recognize and delineate pancreatic masses and to detect them earlier as smaller mass lesions. However, definitive management often cannot be based on clinical and radiological features alone. Despite the advances in the imaging techniques, management options for patients are limited and a malignant diagnosis of solid lesions still carries a high mortality rate. The importance of a cytopathologist in preoperative diagnosis, as a member of the multidisciplinary team, is exemplified in the management of patients with neoplastic cysts. This is based on the pre-operative distinction of non-mucinous and mucinous cysts in general, and benign and malignant cysts in particular. A cytological diagnosis can be obtained with minimally invasive techniques that utilize CT, US or EUS. Endoscopic Ultrasound guided FNA (EUS FNA) is evolving as the diagnostic method of choice due to its ability to more accurately stage the patient during a single procedure using EUS
