Transcarinal needle aspiration for staging subcarinal nodes was performed in 134 consecutive patients with suspected bronchogenic carcinoma at the time of diagnostic fiberoptic bronchoscopy using a prototype 20-gauge by 1-cm needle. The aspiration was performed before examination of the lower airways to avoid cellular contamination. Twenty-four patients had benign primary disease and negative needle aspirates. The transcarinal needle aspirate was positive in 15 percent of the 110 patients with bronchogenic carcinoma. There were no false-positives, and the transcarinal needle aspirate was the only evidence of unresectability in 69 percent (11/16) of those in whom it was positive. In addition, two subgroups of patients were identified in whom the aspirate is most likely to be positive--patients with endobronchial tumors (24 percent; 15/63) and those with an abnormal carina at bronchoscopy (38 percent; 8/21). No complication occurred. We conclude that transcarinal needle aspiration is a low-risk procedure that can save a significant number of patients the morbidity and cost of surgical staging and that it should be performed at the time of diagnostic bronchoscopy in all patients with an endobronchial lesion or a visually abnormal carina.