We thank Dr Annema1 for his thoughtful comments on our article published online in Thorax.2 We observed a significant diagnostic benefit from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the mediastinal staging of potentially operable lung cancer. We believe that our finding is based on differences in EBUS-TBNA and EUS-FNA accessibility to the mediastinum. Additional benefits of EBUS-TBNA in the EUS-centred group were mainly obtained from targeting inaccessible nodes by EUS (2R or 4R). Subcarinal nodes are generally accessible by EUS; however, some parts may not be covered by EUS. Among four metastatic subcarinal nodes diagnosed only by EBUS in the EUS-centred group, the right sides of the subcarinal nodes were not well visualised by EUS in three cases (figure 1). In one patient, performing EUS-FNA on subcarinal nodes was difficult due to a haematoma that developed following the sampling of the 4 L nodes. Of the four cases, two cases were …