We recently evaluated a patient with adenocarcinoma of the right-side lung. The PET scan was interpreted as positive for bilateral hilar and mediastinal node metastasis. EBUS biopsy specimens from both the right-side and the left-side paratracheal and hilar areas demonstrated malignant cells in the right-side biopsy specimen and none in the left. The patient was informed of this finding and told that nonoperative therapy was recommended. She came to us for a consultation. We believed, on review, that the nodes were negative and recommended surgery. During right-side thoracotomy, 18 hilar and mediastinal lymph nodes were removed along with the involved lobe. All lymph nodes were negative for tumor presence. On review of the original EBUS biopsy specimen, lymphoid cells were present along with malignant cells, thus leading to the diagnosis of nodal metastasis. In retrospect, it appears that the false-positive study suggesting metastatic disease resulted from the EBUS needle passing through the node and into the lung or parenchymal tumor, thus the misinterpretation of positive nodal metastasis and the different therapeutic program being recommended.