AbstractThe reliability of bronchoscopic cytology relative to biopsy is controversial. Some still consider biopsy the definitive procedure. Comparative studies are few and limited in scope. Therefore, we compared simultaneously obtained biopsies and cytologies for 224 cases. One hundred and sixty‐six cases (74.6%) correlated completely. Forty‐four cases (19.6%) did not correlate and cytology was diagnostic in 24 of these. Biopsy was diagnostic in sarcoidosis and vasculitis, whereas cytology only excluded the presence of neoplasm or infection. In 14 cases (5.8%), biopsy and cytology showed pathologic changes, but one or the other was more definitive. Rarely, the 2 techniques provided complementary information. A specific diagnosis was obtained more often from the combination of cytology and biopsy than from either alone. However, when biopsy is contraindicated it is reassuring that cytology usually yields the same information as biopsy, and can detect neoplastic and infectious diseases when the biopsy is non‐diagnostic. © 1992 Wiley‐Liss, Inc.