The extent of workup in patients with cervical adenopathy has always been controversial. Extensive workup in the absence of a histologic diagnosis indicative of a malignant process is unwarranted. Although open biopsy may be necessary for certain benign conditions, its routine application for metastatic nodes is not advised. We have used fine-needle aspiration as a routine procedure in the initial evaluation of cervical adenopathy. Over the past 3 years, 140 needle aspirations have been performed. Adequate specimens were obtained in 97 percent of the patients and the diagnostic accuracy was 96 percent. Overall, 45 percent of the patients had the diagnosis of a malignant tumor established whereas others had benign tumors. Metastatic squamous cell carcinoma was diagnosed accurately in all of the patients. Other malignant tumors reported accurately included lymphoma, adenocarcinoma, and metastatic thyroid carcinoma. Among the benign conditions, accurate diagnoses could be established in patients with tuberculosis, chronic lymphadenitis, and hyperplastic lymph nodes. The findings of fine-needle aspiration are helpful in directing subsequent workup. If the findings do not correlate with the clinical suspicion, greater weight is given to the clinical picture and diagnostic workup appropriate for the suspected disease is performed. Proper use of fine-needle aspiration requires close communication between an experienced cytologist and the head and neck surgeon. This series demonstrates that fine-needle aspiration is a safe, accurate, and valuable tool for the evaluation of cervical adenopathy.