RESULTS: 52 procedures from 50 patients were included with a total of 117 lymph nodes biopsied. The mean size of the lymph nodes biopsied was 16 millimeters (mm). 68 lymph nodes were benign, 19 malignant, 16 nondiagnostic, and 14 with other diagnoses. When compared to benign lymph nodes, malignant lymph nodes were associated with older age (71 vs 62 years, p = 0.001), larger lymph node size (25 vs 16 mm, p < 0.001), and inpatient admission (78% vs 63%, p = 0.013). There were no lymph nodes smaller than 10 mm that were malignant. Malignancy was also associated with a high risk smoking status (79% vs 28%, p < 0.001). Although the presence of a lung mass or nodule did not correlate with malignancy, the size of the lesion did (54 vs 27 mm, p < 0.001). African American race (56% vs 86%, p = 0.01), and deep sedation use (68% vs 82%, p = 0.001) were associated with lower risk of malignancy. History of malignancy and presence of trainee were not significantly different. Presence of volume overload on imaging trended toward decreasing incidence of malignancy but was not statistically significant (26% vs 44%, p = 0.09). Complications occurred in 10 out of 52 procedures (19%). Complications included hypoxic and hypercapnic respiratory failure, altered mental status, hypotension, sepsis, cardiac arrest, minor bleeding, SVT, and bradycardia. Almost all events required inpatient admission, usually to the intensive care unit.