A meta-analysis of 18 studies (n = 1,438 patients) has been conducted to determine the accuracy of endoscopic-ultrasonography-guided fine-needle aspiration (EUS-FNA) for differentiating mucinous from nonmucinous pancreatic cystic lesions. EUS-FNA was found to have moderate sensitivity and high specificity for mucinous lesions. The diagnostic accuracy was greatest in prospective studies and those that lasted <36 months. EUS-FNA in combination with cross-sectional imaging could be a useful diagnostic tool for mucinous cysts.