In a study by Plit et al,3 granulomas were seen on ROSE in 46 patients, out of which 43 were sarcoidosis (hence, these 43 were subjected to unnecessary TBLB). In the remaining three cases, two were diagnosed to be anthracosis on ROSE and one as cancer. Hence, 46 patients in total underwent unnecessary TBLB when diagnosis was already made on ROSE. In contrast, only four patients (8%) with nondiagnostic ROSE had sarcoidosis confirmed on TBLB or endobronchial biopsy, thus, justifying the undertaking of additional procedures in this subgroup of patients. EBUS-TBNA with ROSE not only prevented the need to undertake unnecessary TBLB, but informed the bronchoscopist at the same session as to when additional passes and procedures were likely to benefit the patient.3 EBUS-TBNA with ROSE followed by TBLB in a few cases, rather than EBUS-TBNA with TBLB in all cases, would, therefore, provide sufficiently robust diagnostic information with a safety profile that would consolidate its role as the first-line investigation in patients with suspected sarcoidosis. More importantly, it might obviate the need for subjecting patients to unwarranted TBLB and its attendant risks.