Purpose <p>To assess the accuracy and safety of CT-guided percutaneous core-needle biopsies of pancreatic lesions suspected to be malignant based on MRI or CT scans.</p> Materials and methods <p>This retrospective study analyzed CT-guided percutaneous biopsies of suspicious pancreatic lesions performed at our university hospital. Biopsy was performed using a 17G coaxial needle and an 18G core biopsy needle. Data on patient characteristics, lesions, procedures, and histologic results were recorded.</p> Results <p>A total of 90 patients (58.9% males, mean age 65 ± 12.2&#xa0;years) underwent CT-guided percutaneous biopsies. The lesions had a mean size of 36.8 ± 12.2&#xa0;mm and were predominantly located in the pancreatic head 61.1% (55/90). Technical success was achieved in all biopsies 100% (90/90). Most procedures 96.7% (87/90) were performed using direct access routes, while 3.3% (3/90) required indirect transhepatic or transgastric approaches. Among the biopsies, 65.6% (59/90) confirmed malignancy, with adenocarcinoma as the most common malignant subtype representing 55.6% (50/90) of all cases. The rate of non-malignant findings was 26.7% (24/90) including chronic pancreatitis at a rate of 5.6% (5/90) as well as pancreatic pseudocysts and pancreatic cystadenoma each at a rate of 2.2% (2/90), among others. A total of seven cases were identified as false negatives confirmed, but malignancy was later confirmed after re-biopsy or surgery. The initial diagnostic accuracy was 92.2% (83/90). The rate of major complications was 1.1% (1/90), and a total of two minor complications&#xa0;at a rate of 2.2%&#xa0;were observed.</p> Conclusion <p>This study shows that CT-guided pancreatic biopsy is a safe procedure with high diagnostic accuracy.</p>