Medical myths die hard! Drs Farjah and Wood1 point out deficiencies in the ultrasonographic approach that have been disproved by data or overcome by innovative solutions. These include a lack of effectiveness in sampling the radiographically normal mediastinum, an inability of endobronchial ultrasound (EBUS) and esophageal ultrasound (EUS) to collect adequate tissue for molecular analysis, and logistical difficulty in performing EBUS and EUS simultaneously. On the other hand, the authors claim an excellent track record of surgical staging in lung cancer. A survey in 2005 gathered information on the surgical care of the patient with lung cancer and illustrated the poor state of affairs in the United States: Only 27% of surgical patients underwent mediastinoscopy, and only 46% of those undergoing the procedure had documented evidence of lymph node biopsy material submitted to pathology.2 This is one of the reasons why new approaches and opportunities for staging access are desperately needed to provide patients with the best possible care.