The first bronchoscopic study of risk-adjusted diagnostic yields with EBUS was recently published by Ost et al9 as part of the voluntary American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education (AQuIRE) Registry. In that study, the diagnostic yield in 891 patients at six hospitals was between 37% and 54%. In this issue of CHEST (see page 568), Casal et al10 report their experience in sampling 192 mediastinal lymph nodes in 115 patients referred to The University of Texas MD Anderson Cancer Center for EBUS-TBNA. It is, thus, important to have a randomized clinical study evaluating one of the basic aspects of this procedure, such as the needle technique used to obtain the cytologic specimens. Most patients referred (87 [76%]) had a proven diagnosis of malignancy. The investigators evaluated in a prospective, randomized clinical trial the adequacy and diagnostic yield of cytologic samples of lymph nodes obtained using EBUS-TBNA with and without suction. The samples were obtained as part of a staging procedure in the first few stations sampled (usually the nodes that would upstage the patient if malignant), which may explain the low diagnostic value for cancer (<30%), as they were not necessarily conducting the study in the largest or PET scan positive nodes. Despite this low yield, the objective of the randomization was to evaluate cytologic samples by cytopathologists blinded to the technique used in obtaining the sample and the differences in the quality of the sampling between the two techniques. They concluded that both techniques produced similar results with good quality of the samples and an excellent concordance with the final diagnosis. The implication of this study is that the use of suctioning during the procedure does not change the quality of the sample or the diagnosis made during EBUS-TBNA. Even if this does not translate into a significant difference, it does serve to simplify the procedure and may save time without affecting the quality and diagnostic yield of the sample.