Abstract

UNG CANCER IS THE MOST COMmon cancer-related cause of death in the United States. 1 Stage of disease dictates the choice of therapy.Surgery is most appropriate for patients in whom disease is confined to the lung and hilar lymph nodes.For patients with ipsilateral mediastinal lymph node metastases, the benefit of surgery as primary therapy is questionable.For patients with contralateral mediastinal lymph node metastases, surgery is generally not indicated, and chemotherapy, radiotherapy, or both are considered the standard of care. 2 Noninvasive staging with chest computed tomography (CT) or positron emission tomography (PET) is associated with high rates of false-positive and false-negative results, respectively. 3The American College of Chest Physicians recommends invasive staging with tissue confirmation of suspected metastatic mediastinal lymph nodes. 4Mediastinoscopy or thoracoscopy has been the diagnostic standard, but less invasive methods have emerged as poten-tial alternatives.Such methods include blind transbronchial needle aspiration (TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and, most recently, endobronchial ultrasound-guided fineneedle aspiration (EBUS-FNA). 5We hypothesized that EBUS-FNA would be more accurate than TBNA and that the combination of EUS-FNA and EBUS-