Although more informative and precise diagnostic methods have become available, cytologic analysis of sputum is still considered the first step in evaluating bronchogenic carcinoma. We hypothesized that the cost of sputum examinations far outweighed their usefulness in actual patient management. To substantiate this, we retrospectively reviewed the charts of 190 patients with lung cancer who had sputum cytology done at Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas, during the period January 1981 to June 1982. Twenty-three percent of our patients had at least one sputum sample positive for malignant disease, but in only four patients (2%) was bronchoscopy or another procedure avoided by sputum analysis. In most patients with bronchogenic carcinoma diagnosed by sputum cytology, additional invasive diagnostic procedures are not avoided because they are often necessary to stage the disease process. These additional procedures, done for staging, also provide the histologic diagnosis in the majority of patients. Fiberoptic bronchoscopy most frequently provided the diagnosis regardless of positive sputum cytology in our patients, and there was no associated mortality or serious morbidity.