Management of solid pancreatic lesions is still a challenge and requires a multidisciplinary approach. Solid pancreatic lesions often have a malignant potential, so their differential diagnosis should be straightforward and directed to curative treatment. On the other hand, rarely there are solid pancreatic lesions such as lymphoma or focal inflammation that do not require surgical resection. Their distinction from malignancies based solely on the image is not always possible before surgery. In cases where the indication for pancreatic resection is controversial, fine needle aspiration or biopsy of solid pancreatic lesions is the most accurate method in the differential diagnosis. Knowing the correct indications of endosonography and fine-needle sampling will allow for the rapid and effective diagnosis of these usually malignant lesions for the benefit of patients.