Background: Endoscopic ultrasound elastography is an imaging modality that has recently been proposed for the visualization and evaluation of tissue elasticity. This study aimed to assess the role of EUS elastography in the diagnosis of pancreatic mass lesions in comparison to EUS fine needle aspiration (FNA) biopsy and to differentiate between benign and malignant lesions. Methods: This was a cross-sectional study that was conducted on 53 patients are coming to hospital suspected to have pancreatic mass clinically (jaundice, cachexia epigastric pain) or radiological (ultrasound, Computed tomography (CT) and/or Magnetic resonance imaging (MRI) of the abdomen) Endoscopic Ultrasound Elastography was done and strain ratio was calculated and fine needle aspiration was done for histopathological examination. Results: Regarding the Pancreatic FL on EUS elastography was hard in 42 (79.25%) patients and soft in 11 (20.75%) patients. Strain ratio of hard Pancreatic FL on EUS elastography was significantly higher than soft Pancreatic FL on EUS elastography. The type of lesion by histopathological examination, 37(69.81%) patients had adenocarcinoma, 11(20.75%) patients had Chronic pancreatitis and 5(9.4%) had neuroendocrinal tumors. EUS- strain ratio can significantly predict the type of Pancreatic FL (malignant or benign) with AUC =0.909, with 100 % sensitivity, 100%specificity, 98%PPV and 93.7%NPV, P value