In our series including 115 patients, diagnosis was obtained in 65% by CDT, 79% by TBNA, and 91% by TBNA plus CDT. Twenty-four of 30 cases diagnosed by TBNA alone were in the peribronchial disease group (34.3% of the peribronchial disease group) [Fig 1]. The addition of TBNA to CDT increased sensitivity significantly only in this group. These findings seem to correlate with the reports of Gullon et al5on cost-effectiveness, although no cost analysis was carried out for our study. FB had a diagnostic value of 67 to 100% in lung cancer cases with EML. Inadequate tissue sampling due to the presence of necrosis, a blood clot on the lesion, or formation of crush artifacts by FB make TBNA an indispensable tool in these lesions.6–7,10,12–13 Considering EML, Dasgupta et al7 reported 72% sensitivity with FB, 78% with TBNA, 84% with CDT, 97% with TBNA plus CDT, and the increase in sensitivity by addition of TBNA to CDT was not significant. These findings were confirmed by Bilaceroglu et al,14who found that the rates of diagnosis for EML were 88% with FB and 94% with TBNA. Contradicting previous analyses, Karahalli et al15 reported that FB had the highest diagnostic rate in EMLs, and no additional benefit was detected with combination of TBNA and FB. In our study, in 13 patients with EML, the addition of TBNA to CDT increased sensitivity, without a statistically significant difference. Unlike EML, the diagnostic yield of CDT was low in submucosal and peribronchial diseases, where the mucosa was generally intact. TBNA enables penetration into the submucosa and access to the tumor through the bronchus wall in peribronchial disease, and usually diagnosis is available solely by TBNA.7,10,13 Khoo et al1 reported that sensitivity of TBNA was 89% in submucosal disease and 83% in peribronchial disease. In the study of Shure and Fedullo,6 the sensitivity of FB was 55% for submucosal disease and peribronchial disease and that of TBNA was 71%, with the difference being insignificant. Addition of TBNA to FB increased the diagnostic rate to 89%, and this rise was statistically significant.6In two different analyses, Dasgupta et al7 and Govert et al 11 found the combination of TBNA and CDT to have increased sensitivity compared to CDT alone. In contrast, Karahalli et al15and Lundgren et al16 reported that TBNA had a lower diagnostic yield than FB in submucosal disease.15–16 In our series, when submucosal and peribronchial diseases were considered together, the diagnostic yield was 63% with CDT, 78% with TBNA, and 90% with the combination of both. As a result, the addition of TBNA to CDT made a significant increase in the diagnostic rate. If submucosal and peribronchial diseases were considered separately, by addition of TBNA to CDT, sensitivity increased from 84 to 97% in submucosal disease without a statistical significant difference. In peribronchial disease, the diagnostic rate was 52% by CDT, 87% by TBNA plus CDT, and the superiority of combination over CDT was significant (p < 0.001).