The first endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA) was performed in 1991 for the diagnosis of mucinous cystadenoma of the pancreas.1 Since then, endoscopic ultrasound imaging has advanced with regard to the diagnosis of pancreatic lesions, as well as other organs, providing the possibility of collecting materials for cytologic and/or anatomopathologic analysis with low risk of adverse events,2,3 with an estimated sensitivity of 85%–93%.4 However, the diagnostic yield of EUS-FNA continues to be a challenge and is influenced by variables such as lesion characteristics, endosonographer experience, needle properties, ability to puncture the lesion, technique and number of punctures, immediate cytologic evaluation, sample preparation, and pathologist interpretation.