It is not unusual to have considerable difficulty in proving the presence or absence of a malignant tumor deep in the head of the pancreas that is producing an obstructive jaundice. A surgeon is often reluctant to mobilize the head of the pancreas adequately and to carry out a biopsy to prove the presence of tumor because of potential complications, such as hemorrhage or a pancreatic fistula and because of the poor accuracy of frozen section in differentiating between adenocarcinoma and chronic pancreatitis. A transduodenal needle biopsy is utilized by some to obtain sufficient material for frozen-section diagnosis. Proof of the diagnosis may not be possible before proceeding with pancreaticoduodenectomy. The surgeon must use his judgment to establish a reasonable diagnosis based on the gross findings. If the lesion is not resectable and palliation is to be provided by such surgical procedures as cholecystoenterostomy and gastroenterostomy, chemotherapy, and radiotherapy, then microscopic proof of cancer diagnosis is required. It permits a more rational plan for the patient's care, which may extend over a long period. The surgeon must decide whether the best approach for the biopsy of the tumor is anterior or posterior (Figure 8). A biopsy needle, such as the large Tru-cut type, can be inserted into a deep-seated tumor and biopsies taken. If the pathologist is hesitant to provide a diagnosis from the minimal amount of tissue available, the surgeon must consider the possibility of proceeding with a wedge biopsy using a small knife blade (Figure 9). Alternatively, he may send additional needle biopsies for permanent histology, which is more accurate than frozen section.