Lung cancer remains the leading cause of cancer deaths in the United States, accounting for an estimated 29% and 26% of deaths in 2012 in men and women, respectively.1 Outcomes of patients with lung cancer vary dramatically on the basis of stage, with a 5-year survival ranging from 73% for stage IA to 13% for stage IV.2 Therefore, accurate staging of lung cancer plays an essential role in patient management, dictating the optimal treatment or combination of treatments with surgery, chemotherapy, or radiation therapy. Of particular interest for precise staging is the determination of metastatic involvement in mediastinal lymph nodes. Although radiographic imaging can be helpful, it suffers from low sensitivity (chest CT scan) or low specificity (PET scan).3 Tissue sampling remains the most accurate method to make this determination, following the cliché “tissue is the issue.” Mediastinoscopy has been the standard approach to mediastinal tissue biopsy for decades, but more recently, newer ultrasonographic endoscopic technology has emerged as a sensitive and less invasive mediastinal sampling approach. This technology includes endobronchial ultrasound (EBUS) and esophageal ultrasound (EUS) used separately or in combination. In this point editorial, we argue that EBUS- and EUS-guided transbronchial needle aspiration of the mediastinum should be the preferred first approach to mediastinal staging in lung cancer over cervical mediastinoscopy (CM) because of their high sensitivity, low morbidity, and reduced cost.