Induction therapy followed by surgery is an option for treating patients with stage IIIA NSCLC with discrete mediastinal node involvement.7 Studies demonstrate the benefit of induction chemotherapy to surgical resection for patients with clinical N2 disease.46 If this approach is chosen, the role of mediastinal restaging after induction therapy remains unclear, but downstaging and complete pathologic response are good prognostic factors. Some authorities suggest that surgery should only be performed in those patients who have a response in the mediastinum to induction therapy. In this regard, both CT and PET imaging for restaging have been shown to be inaccurate.47 Invasive restaging, therefore, is warranted if restaging is to be performed. Restaging of the ipsilateral N2 nodes by VATS has been done, but this is limited by radiation and sometimes anatomy (ie, 4R station), resulting in a sensitivity of only 67% and NPV of 73%.48 A repeat mediastinoscopy has a sensitivity of about 70% to 82% but may pose a technical challenge, and in some series the sensitivity was as low as 30%.12 As a general concept, the less invasive the staging is, the easier the restaging. Because a first-time mediastinoscopy may be the optimal way to accomplish mediastinal restaging, an argument can be made to always use a needle-based technique initially to document N2/3 involvement, as suggested by current guidelines, and to save mediastinoscopy, if needed, for restaging after induction therapy (Fig 6). Two studies, however, show that EBUS has a sensitivity of 64% and 76%, respectively, for restaging,49,50 so that EBUS may be attempted as a first restaging technique. There is still no reliable way of restaging the mediastinum, and none of the above-mentioned methods can be considered preferred. The choice may depend on the availability of EBUS, surgical expertise, and the invasive method used for the initial staging.