Not mentioned in the article is the fact that patients with lung cancer often also have COPD with a compromised pulmonary function. It is obvious that an esophageal approach is less troublesome for those patients. However, it needs to be stressed that the EUS approach is excellent for diagnostic purposes but not for complete mediastinal staging for which the combined EBUS and endoscopic ultrasound using the EBUS scope approach is advised. As recently discussed in CHEST, the question now is not whether to implement EUS (B) in pulmonary practice but how to organize training and implementation. The challenge to mastering EUS (B) is not the actual sampling, but learning the mediastinal anatomy from an esophageal perspective and relating the various lymph nodes to the vascular structures and the lymph node map. We demonstrated that pulmonologists can learn EUS and achieve similar results as experts using a dedicated implementation strategy. In another study, assessing learning curves for mediastinal EUS, we found that pulmonologists with knowledge of lung cancer staging and experience in bronchoscopy quickly improved their performance in EUS-guided fine-needle aspiration. However, acquisition of skill varied considerably between individuals and 20 procedures were not enough to ensure consistent and competent performance. To facilitate the learning of mediastinal EUS, we developed an EUS assessment tool and demonstrated that competency in mediastinal staging of non-small-cell lung carcinoma could be assessed in a reliable and valid way. Measuring and defining competency and training requirements could improve EUS quality and benefit patient care.