Transbronchial needle aspiration (TBNA) of hilar and mediastinal lymph nodes through the flexible bronchoscope has been available for the past two decades and has been shown to be an effective technique in the diagnosis and staging of lung cancer . TBNA can sample lymph node areas that are accessible to standard cervical mediastinoscopy thereby avoiding the risks of mediastinoscopy and offering potential cost savings. In addition, TBNA may offer access to lymph nodes that cannot be sampled by cervical mediastinoscopy. Several papers have reported the yield of TBNA , but the cost effectiveness of TBNA has not been directly studied and only estimated in a hypothetical cohort of patients . We retrospectively reviewed our experience with TBNA to examine both the yield and cost effectiveness of the procedure in the Mackenzie Health Sciences Centre, Edmonton, Alberta.