The fifty six-year-old Transbronchial Needle Aspiration (TBNA) has proved its efficacy, safety and cost-effectiveness particularly in diagnosing and staging lung cancer as well as in diagnosing benign granulomatous disease: sarcoidosis and tuberculous lymphadenitis. Although highly specific, the sensitivity and accuracy of TBNA may vary depending on the study methods, patient population (severity of disease) and prevalence of mediastinal metastasis. Conventional "blind" TBNA should be a "sine quo non" of routine bronchoscopy. However, it has not been used as extensively as it deserves to be owing to a multitude of factors ranging from concerns about its efficacy and safety to cost. Cost of the transbronchial aspiration needle might have an important impact on underuse of TBNA particularly in developing countries and therefore cost of the needles should be either adapted to the income of the countries or should be manufactured locally. Experience and training will, no doubt, improve TBNA performance and yield considerably.