When can a negative endosonographic examination be trusted?

Extract We read with great interest the recently published European Respiratory Society/European Society of Gastrointestinal Endoscopy/European Society of Thoracic Surgeons clinical practice guideline on endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer [1]. We congratulate the task force for this important update. Nevertheless, we believe that recommendation 4 raises a question that extends beyond the role of confirmatory mediastinoscopy itself.