For a study, researchers sought to understand the superiority of either of the 2 techniques, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB), which was still up for debate. While sampling each solid lesion and pancreatic lesion separately, this meta-analysis assessed the security and diagnostic effectiveness of those 2 needles. They searched PubMed, EMBASE, and the Cochrane library for controlled trials comparing FNA with FNB in a solid mass. The outcome measures included the accuracy of the diagnosis, the number of needle passes, the sufficiency of the diagnosis, the presence of tissue cores, and adverse events. The standard error, upper and lower confidence intervals, and risk at a 95% confidence level could all be calculated using Review Manager Version 5.3, which was also used to create forest plots for pooled analysis. The random or fixed effect model was employed in accordance with the heterogeneity (I2). A total of 2,718 patients from 18 studies with randomized control trials were included in the meta-analysis (1,141 patients underwent EUS-FNA, 1,108 underwent EUS-FNB, and the remaining 469 patients were sampled with both needles alternately). FNB group has relatively good diagnostic accuracy relative risk (RR): 0.94, 0.92-0.97; P=0.0002), diagnostic adequacy (RR: 0.95, 0.9-1.0; P=0.04), and high quality histologic yield compared (RR: 0.77, 0.64-0.93; P=0.007) with the FNA group in solid gastrointestinal lesions, and the number of needle passes to obtain sufficient tissue (mean difference: 0.54, 0.45-0.64; P<0.00001) was lower in the FNB group. For solid pancreatic disease only, there was no difference in diagnostic accuracy (RR: 0.97, 0.93-1.01, P=0.13) or quality histologic yield (RR: 0.60, 0.29-1.23; P=0.16). The rate of adverse events (RR: 1.04, 0.48-2.29; P=0.92) did not significantly differ between FNA and FNB groups. In solid gastrointestinal lesions, FNB was associated with fewer needle passes, comparatively better diagnostic adequacy, and greater rates of tissue cores. For solid pancreatic disease alone, neither the accuracy of the diagnosis nor the frequency of tissue cores has changed.