Objective To explore the value of pathologic diagnosis for pancreatic head mass by using recise Tru-cut biopsy under intraoperative ultrasound guided. Methods Twenty-eight patients with solid pancreatic masses in People’s Hospital of Suqian，Affiliated Hospital Xuzhou Medical College from August 2010 to August 2011 were performed precise Tru-cut biopsy under intraoperative ultrasound guided. In all patients of 28 cases, male 20 cases and female 8 cases, the male-to-female ratio was 5∶2. The patients’ age was 34-78 years old（mean age： 64 years old）. Twenty-eight patients were divided into three groups based upon the greatest dimension of the masses as follows：equal or less than 1.5 cm （group S, 5 cases）, 1.5-3.0cm （group M, 7 cases）, and greater than 3.0cm （group L, 16 cases）. Three needlepasses in each mass were performed. The results of postoperative pathologic findings were compared with specimens in paraffin sections. Results In all cases of 28, the diagnostic coincidence rate was 100%, there were no false positive finding and false negative. The coincidence ratio for pathological diagnosis of tissues with only 1 strip sample （1/3）, only 2 strip samples （2/3）, and with 3 strip samples （3/3） were 3/5, 2/5, and 0/0, respectivly in S group, 0/0, 5/7, and 2/7, respectivly in M group, and 0/0, 4/16, and 12/16, respectivly in L group. The false negative rate of single strip sample in S group and M group was higher than that in L group （χ2=9.833，P=0.002）. There was false negative finding with master single test in small focus of infection. Conclusion Precise Tru-cut biopsy under intraoperative ultrasound guided is a safe and highly accurate method for pathological diagnosis of patients with solid pancreatic lesions, especially in small lesions，it is worthy of clinical application..