Mediastinal staging directs optimal lung cancer therapy and provides the patient with an important initial prognosis. Performed for > 50 years, mediastinoscopy is effective, safe, and efficient. Technologic advances have yielded additional procedures for mediastinal staging, including endobronchial ultrasound (EBUS)- and esophageal ultrasound (EUS)-guided nodal aspiration. Although effective in confirming malignancy in an enlarged lymph node or a lymph node that was positive on PET imaging, these procedures do not reliably and systematically sample all mediastinal nodes or acquire sufficient tissue for molecular analyses. New technology may appropriately be adopted when it is at least as effective as a standard and offers advantages in terms of safety, efficiency, access, and costs. This premise has not been established for EBUS and EUS. Accordingly, the assertion that endosonography should be the preferred modality for invasive mediastinal staging is unsubstantiated.