Lung cancer is the leading cause of cancer deaths worldwide and is responsible for more cancer deaths than the next three most common cancers combined. Despite common use of the best non-invasive tests for assessing clinical stage: computed tomography (CT) and integrated positron emission tomography/computed tomography (PET/CT) using 2-deoxy-2-18-fluoro-D-glucose (FDG), the pathologic stage is often different. The status of mediastinal (N2) lymph nodes is paramount in guiding therapy towards surgery, chemotherapy, radiotherapy or a combination of these modalities. Accurate staging is mandatory for patients prior to commencing therapy. Invasive tests that afford tissue biopsies of N2 lymph nodes are: esophageal ultrasound with fine needle aspiration (EUS-FNA), endobronchial ultrasound (EBUS-TBNA), and mediastinoscopy. This review article compares the two most commonly used invasive methods to obtain tissue biopsies of mediastinal (N2) lymph nodes: mediastinoscopy and endobronchial ultrasound (EBUS). © 2011 Tianjin Lung Cancer Institute and Blackwell Publishing Asia Pty. Ltd.