The purpose of this study was to evaluate the role of transbronchial needle aspiration (TBNA) in the diagnosis of peripheral lung lesions. We attempted to perform TBNA in 37 patients referred to our hospital for diagnostic evaluation of radiographically evident peripheral masses (23 cases) or nodules (14 cases). None of them had bronchoscopic evidence of endobronchial lesion. The aspirations were performed under fluoroscopic guidance, through a fibreoptic bronchoscope, employing a 21-gauge, 1.3 cm aspirating needle. They were preceded by bronchial brushing and followed by transbronchial biopsy (TBB) of the peripheral lesion. In two cases, the apical nodules were not accessible by any of these procedures. Bronchial washings were also collected immediately after each procedure (brush, TBNA and TBB). TBNA was diagnostic in 23 of 37 patients (62%) rendering the TBNA yield considerably higher than washing (24%), brushing (27%) or TBB (38%). The addition of TBNA to the combination of TBB, brushing and washing, significantly increased the yield of fibreoptic bronchoscopy in our series from 46% to 70%. No significant complications, such as pneumothorax or major bleeding, occurred either with TBNA or TBB. In conclusion, our findings suggest that transbronchial needle aspiration is a safe procedure, that can improve the diagnostic yield of bronchoscopy in the diagnosis of peripheral lung masses or nodules.