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Introduction and Objective EBUS-TBNA/TBNB is the gold-standard for real-time evaluation of mediastinal and/or hilar lymph nodes. The EBUS bronchoscope can be inserted through the esophageal route for needle aspiration of lymph nodes close the esophagus (EUS-B-FNA). A meta-analysis involving lymph node staging of lung cancer demonstrated a higher diagnostic yield of EUS-B-FNA in combination with EBUS-TBNA than using EBUS-TBNA alone (91% vs. 80%, p = 0.004). Regarding patients with undiagnosed mediastinal with/without hilar lymphadenopathy and without parenchymal lesion suspected for lung cancer, there is no similar study in the literature regarding the comparison of EBUS-TBNA/EUS-B-FNA with EBUS-TBNA alone.The aim of the study is to demonstrate the diagnostic value of the combined approach compared with EBUS-TBNA alone in undiagnosed mediastinal lymphadenopathy.Methods Prospective single-center study of patients with mediastinal with/without hilar lymphadenopathy on imaging (CT, PET/CT) including at least 2 lymph node stations with at least one of them involving the subcarinal or the left inferior paratracheal lymph node (EUS-accessible stations). Patients with intraparenchymal lesion suspicious for lung cancer are excluded from the study.Patients are randomized into 2 groups (EBUS-TBNA/TBNB alone and combination of methods) according to two parameters of randomization. These are gender (male or female) and the short axis of the smallest lymph node (7 and/or 4L) from which the biopsy will be taken (≤ 15 mm or > 15 mm).We defined samples as diagnostic when a definitive diagnosis (malignancy or benign disease) has been made. Patients with non-diagnostic sample results underwent other invasive procedures or follow-up of at least six months.Results So far, 47 patients have been enrolled in the study. Six patients are in follow-up. The diagnostic yield for EBUS and EBUS/EUS is 90,9% and 94,7% respectively ( table 1).Abstract P212 Table 1Conclusions At first glance, the combination of EBUS-TBNA/TBNB with EUS-B-FNA/FNB does not seem to be superior to EBUS-TBNA/TBNB in terms of diagnostic accuracy in undiagnosed mediastinal lymphadenopathy, however it is worth noting that 3 patients in the EBUS/EUS-B group were diagnosed only with the EUS-B-FNA samples, adding 16.7% to the diagnostic performance of the test.