Fine needle aspiration (FNA), used as a diagnostic tool in the primary diagnosis of soft tissue tumors, has never been critically examined. On the basis of 25 years of experience at the Musculoskeletal Tumour Centre in Lund, Sweden, the benefits, limitations, and requirements for optimal use of FNA and cytodiagnosis in the definitive treatment of soft tissue tumors are discussed. The benefits of FNA outweigh the limitations when the following requirements are fulfilled: referral of patients to specialist centers according to specific guidelines, a multidisciplinary approach to reach a reliable pretreatment diagnosis, and close cooperation among the different specialists involved, especially between the cytopathologist and the orthopedic surgeon.