Diffuse mediastinal lymphadenopathy may be caused by infection, malignancy, or sarcoidosis, and often requires mediastinoscopy for diagnostic lymph node biopsy. Preliminary data show that transesophageal endoscopic ultrasound-guided fine-needle aspiration may be an accurate and less invasive alternative to mediastinoscopy. This article reviews the technique's utility in obtaining material diagnostic of nonnecrotizing granulomas in patients with enlarged posterior mediastinal lymph nodes and suspected sarcoidosis, and describes our center's experience.