Rationale: To assess feasibility and yield of diagnostic procedures after active case finding for tuberculosis with radiological screening at the three main entry points for asylum seekers to Switzerland. Method: Prospective multi-center study on the value of symptoms, spontaneous and induced sputum, and bronchoscopy for the confirmation of tuberculosis in radiological suspect cases. Results: Among 101 asylum seekers examined, spontaneous sputum was collected on-the-spot in 83 and yielded 7(54%) of 13 smear- and 13(39%) of 33 culture-positive cases. Morning sputum, collected in 84, yielded 8(62%) and 16(49%), and the two combined 9(69%) and 20(61%), respectively. Two additional induced sputa, collected in 91, yielded no additional smear-, but 7 culture-positive cases (yield 82%). Bronchoscopy, performed in 87 of 92 sputum-smear negative cases, yielded 4 additional smear- and 6 culture-positive cases. Culture confirmation was independently and significantly predicted by obtaining a specimen from bronchoscopy (adjusted odds ratio (AOR) 11.0, 95% confidence interval [CI] 1.9-62) and a prior decision to treat (AOR 3.0, CI 1.1-8.1). Conclusion: Radiographic anomalies compatible with tuberculosis found during screening are a poor guide to initiation of treatment. Respiratory and systemic symptoms correlated weakly with culture confirmation of tuberculosis. All radiological suspect cases must be examined with on-the-spot and early-morning sputum, irrespective of symptoms. If both specimens are smear-negative, the yield is increased by bronchoscopy and, to a lesser extent, by 2 samples of induced sputum. The examination of any single specimen has a low yield of 36% to 63% and is insufficient to exclude active tuberculosis.