Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. Design: Retrospective review of a prospectively maintained database; noncomparative. Setting: Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. Main Outcome Measurement: EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses. 1. Background Lung cancer represents the most common cause of cancer and cancer-related mortality [1]. Treatment strategy largely depends on the tumor stage, with tissue confirmation considered necessary to provide therapy. Pulmonologists and thoracic surgeons have classically relied on bronchoscopy (forceps biopsy of lumen tumor and/or blind transbronchial fine needle aspiration), computed tomography- (CT-) guided fine needle aspiration/biopsy (FNA), mediastinoscopy, or thoracoscopy for diagnosis [2]. The technique selected usually depends on local expertise and tumor and nodal location. The accuracy of each of these techniques is limited and each is associated with notable morbidity [2]. The sensitivity of bronchoscopically guided biopsy is poor, as it fails to reach a definitive diagnosis in 20 to 30% of patients [3]. CT-guided FNA provides a diagnostic accuracy of 77% to 95%, but is largely limited to sampling of masses larger than 2？cm in size and may result in pneumothorax in as many as 22%–62% of patients [4–6]. In addition, CT often cannot be performed in lesions abutting or located in close proximity to large mediastinal vessels [7]. While surgical techniques such as mediastinoscopy or thoracoscopy provide excellent diagnostic
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