Liver cystic echinococcosis (CE) in non-endemic areas poses several problems in the differential diagnosis of various space occupying lesions detected by US examination. Fine needle aspiration biopsy (FNAB) using teflon covered needles with a US visible marker may be very useful for the definitive diagnosis. In the Clinic of Parasitic and Tropical Diseases in Poznan, FNAB were performed in 121 patients with liver space occupying lesions, with an addition of an anthelmintic cover of albendazole. The biopsy material was examined parasitologically, cytologically, bacteriologically and immunologically. E. granulosus infection has been confirmed in 25 patients (20.6%), in 16 cases by finding parasite protoscoleces or hooks and in nine cases by detection of an antigen specific for E. granulosus, antigen 5 (Ag5). Additionally nine cases of malignancy (7.4%), four of angioma (3.3%) and three bacterial abscesses (2.5%) were diagnosed. There were no complications related to FNAB puncture. The algorithm of the clinical management of space occupying lesions suspected for CE was proposed. FNAB is a very important technique in the differential diagnosis of cystic echinococcosis.