The strengths of the study are that it was a randomized, head-to-head comparison of a new technology with a conventional technique and that it used a strictly standardized protocol for biopsy procedures. However, the study also has some drawbacks: mainly, the results come from a single operator, raising the question of whether the outcome reflects the impact of the technology or the skill of the operator. The sample is relatively small, and the targets were either peripheral or mediastinal lymph nodes, locations for which the impact of guidance systems may differ; and due to the small numbers, proper subgroup analysis are not possible (and apparently were not included in the initial study design). Lastly, the study compares conventional bronchoscopy with a rarely used guidance technology in bronchoscopy. Comparisons with more widely used systems, such as electromagnetic navigation, may have been more useful.