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Finally, we have also questioned the utility of EBUS grey zone textural analysis proposed in a recent study [5] to add weight to the EBUS-TBNA, especially when the pathology is equivocal. In our recent observational study [6] , we found this technique less useful and we feel that a larger randomised trial is again needed. Perhaps this issue could be addressed in future guidelines after these studies will have been completed to give further clarity in this area.

Needle Gauge and Grey Zone Analysis in Endobronchial Ultrasound-Transbronchial Needle Aspiration: The Need for More Randomised Evidence