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system in tandem with a local imaging method, such as endobronchial ultrasound, may also be useful. We appreciate the authors providing the 5-year experience of their institution. Preoperative diagnosis was made in 107 of 142 patients (75%) in advance of their lung cancer operations; the rate for preoperative diagnosis of peripheral lesions was 79% (58 of 73 patients). This rate is excellent by today’s standards; stratification of yield by size would be useful in view of the wide range in lesion size (1 to 10 cm). We support the idea of a bronchoscopy initiative that would allow our specialty to measure individual and collective lung cancer diagnostic performance and to work toward an even higher yield. At present, many clinicians send patients with stage T1 ( 3 cm) and T2 ( 3 cm) [N0] lesions to undergo resection without a preoperative tissue diagnosis. The most obvious limitation is that nonmalignant lesions (and normal lung) are occasionally resected. If neoadjuvant chemotherapy ever becomes the standard of care for these early-stage lesions, the need for improved preoperative diagnosis will become even more urgent.