The answer is (hold your breath)—not yet. But the evidence continues to accumulate for the efficacy of endobronchial ultrasound (EBUS) and esophageal ultrasound fine needle aspiration (FNA) approaches to mediastinal staging in non-small cell lung cancer (NSCLC). In this issue of the Journal, Ernst and colleagues 1 present a provocative study of the diagnostic yield of EBUS-FNA versus mediastinoscopy in patients with suspected or confirmed NSCLC. Patients underwent both procedures either concurrently or within a 1 week interval. Results were compared with surgical mediastinal lymph node dissection at the time of lung resection. EBUS-FNA overall had a higher diagnostic yield than mediastinoscopy in 66 patients. The majority of the differences observed between the two modalities appeared to occur in sampling station seven. The authors conclude that EBUS-FNA may be preferred in the histologic sampling of paratracheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy. What’s that you say? Mediastinoscopy has long been the gold standard in mediastinal staging, with its origins in the pre-CT and positron emission tomography (PET) scan days. Historically, it has been the key modality for accurate prelung resection staging of the mediastinum, and continues to be used routinely in many centers for all patients with suspected or confirmed NSCLC. The arrival of endoscopic staging approaches as new kids on the block has evoked visceral responses from many in the surgical old guard. Their promise as useful tools however continues to be demonstrated, leading to adoption by pulmonologists, gastroenterologists, and thoracic surgeons alike. Will endoscopic mediastinal staging replace mediastinoscopy? Although it may well find a place as the first line approach, clearly more data is needed. Some cautionary notes remain. The data we have seen so far here and from others 2 is really by the innovaters in endoscopic staging, and may not be representative of real world results. Our own experience using endoscopic staging as a front-line approach suggests that false-negatives revealed by subsequent mediastinoscopy do occur. That being said, results from mediastinoscopy itself are not universally equal. At present, operator “dose” is clearly variable for both endoscopic staging and mediastinoscopy, as are the subsequent results. Sorting out where and when endoscopic staging works and doesn’t work best is clearly the next step. One area of concern in interpreting results from the current study is the relatively poor results in the mediastinoscopy arm with respect to sensitivity and negative predictive value, particularly in the context of lymph nodes 10 mm. This does not compare well with other results available in the literature, specifically the 5.5% false negative rate of