Nine patients with a history of adenoid cystic carcinoma (ACC) arising in the head and neck and in whom transthoracic fine-needle aspiration (FNA) was performed to investigate pulmonary lesions are described. FNA yielded a definitive diagnosis of metastatic ACC in all cases. In six of the nine patients, the pulmonary metastases were asymptomatic. Lung lesions were discovered up to 19 years after primary tumor presentation, and in two, pulmonary spread was the only evidence of recurrent disease. On the basis of the FNA diagnosis, these two patients were treated surgically for their isolated pulmonary metastases, and are disease free at 107 and 139 months. Six of the nine patients received radiation or chemotherapy; one initially refused treatment. Thoracotomy was avoided in these patients on the basis of the FNA diagnosis. All are alive with disease at 25 to 246 months. The metastatic tumors were indistinguishable cytologically from two primary pulmonary ACCs that were available for comparison. Our experience suggests FNA is a useful tool in the diagnosis of ACC in pulmonary material--one which obviates the need for thoracotomy with its associated morbidity.