Fine-needle aspiration for suspicious extrapelvic lesions is documented in 82 specimens from patients with known pelvic malignancy. Specimens were obtained from lung (39%), supraclavicular lymph nodes (24%), paraaortic lymph nodes (11%), liver (7%), and other sites. Three of 32 (9.4%) patients with transthoracic aspirates experienced pneumothoraces requiring chest tube placement, and three others had smaller pneumothoraces that resolved spontaneously. Fifty-nine (72%) specimens were positive for malignancy. There were no known false positives. Of six negative aspirates that had follow-up histology, there were two false negatives. When the subsequent course was used as an indication of accuracy, specificity was 100%, and sensitivity was 91%. Fifty-eight (71%) patients had therapeutic alterations as a direct result of aspiration diagnosis. Thirty-nine major operative procedures and 28 open biopsies were spared. Fine-needle aspiration is a reliable and cost-effective diagnostic method that should become an increasingly routine component of the diagnostic armamentarium and may have broader roles defined through continuing study.