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Available staging techniques have limited accuracy in choosing those lung cancer sufferers without regional lymph node metastases. With EUS-FNA, an ultrasound transducer incorporated along with an endoscope allows the investigator to visualize and insert the aspiration needle into mediastinal lymph nodes under real-time ultrasound guidance. The EUS-FNA examination includes a sensitivity of 88 % and a specificity of 91 % in analyzing mediastinal lymph nodes. To date it is not known how EUS-FNA compares with mediastinoscopy, nor to what extent the combination of EUS-FNA and mediastinoscopy improves preoperative staging.