Transthoracic needle aspiration biopsy (TNAB) is a useful diagnostic technique in the evaluation of thoracic disease. Previous reports have shown that this technique has a high positive but a low negative predictive value. The latter has limited the clinical usefulness of a negative biopsy. To improve the reliability of a negative TNAB, a series of thoracic needle biopsies was done using a team approach, having a cytopathologist, with the necessary equipment to examine the biopsy specimens, in attendance at the biopsy. As biopsy specimens were obtained, they were reviewed to ensure an adequate and representative sampling. The positive predictive value was 98.6 percent and the negative predictive value was 96.7 percent. The high negative predictive value obtained using this approach allows clinical decisions to be based on the results of a negative TNAB.