We performed 25 percutaneous fine needle biopsies (PFNB) on pediatric patients during a 3-year period. Of 17 patients with proven malignancies, PFNB was true positive in 16 and false negative in one. In nine patients with benign or inflammatory disorders, there were three true positives and six false negatives. There were no complications either from PFNB or larger caliber core biopsies, which were also performed in selected cases. All procedures were performed with ultrasound and/or fluoroscopic guidance. General anesthesia was not required, except in cases where PFNB was performed together with a surgical procedure. PFNB is as accurate and safe in pediatric patients as in adults. It should be considered prior to any open surgical procedure performed for biopsy alone.