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In a series of 580 tumours of the anterior mediastinum, after exclusion of 102 goiters, 242 tumours were surgically explored and 236 were first biopsied: 43 needle biopsies and 193 surgical biopsies; 25 biopsies had to be repeated with another technique. The rate of needle biopsies was 8.9% and the rate of surgical biopsies was 40.3%. The percentage of secondary tumour resections was 13.5% (32 on 236). The decision between primary resection and biopsy is based upon a combination of clinical, radiological and laboratory arguments. For more than half the tumours which develop in the anterior mediastinum, a definite tissue diagnosis must precede the treatment.