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We thank Dr Nosotti and colleagues for their interest [1Nosotti M. De Simone M. Cioffi U. Ultrasonography-guided transbronchial needle aspiration and microRNA: return to the past?.Ann Thorac Surg. 2013; 96 (letter): 377-378Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] in our recent article on the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples for messenger RNA and microRNA microarray analysis [2Nakajima T. Zamel R. Anayama T. et al.Ribonucleic acid microarray analysis from lymph node samples obtained by endobronchial ultrasonography-guided transbronchial needle aspiration.Ann Thorac Surg. 2012; 94: 2097-2101Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar]. As the authors described, EBUS-TBNA is widely accepted as a minimally invasive nodal staging modality in patients with lung cancer and the samples obtained by EBUS-TBNA can be used for molecular testing as well. On the other hand, clinicians have to understand the importance of the acquisition and processing of needle-biopsied material for pathologic diagnosis and molecular analysis [3Bulman W. Saqi A. Powell C.A. Acquisition and processing of endobronchial ultrasound-guided transbronchial needle aspiration specimens in the era of targeted lung cancer chemotherapy.Am J Respir Crit Care Med. 2012; 185: 606-611Crossref PubMed Scopus (61) Google Scholar]. To optimize the efficacy of EBUS-TBNA, special attention needs to be paid to both technical and methodological aspects of the procedure. We have already introduced our experience with how the sample acquisition and processing were performed [4Nakajima T. Yasufuku K. How I do it–optimal methodology for multidirectional analysis of endobronchial ultrasound-guided transbronchial needle aspiration samples.J Thorac Oncol. 2011; 6: 203-206Crossref PubMed Scopus (83) Google Scholar] and how to simultaneously isolate RNA, DNA, and protein from tiny cytologic material [5Nakajima T. Anayama T. Koike T. et al.Simultaneous Isolation of Total RNA, DNA, and Protein Using Samples Obtained by EBUS-TBNA.J Bronchology Interv Pulmonol. 2011; 18: 301-305Crossref PubMed Scopus (20) Google Scholar] to maximize the usability of this unique sample. Although we know the limitations of EBUS-TBNA samples, we believe that we are heading in the right direction to lead patient treatment to less invasive modalities. To overcome the limitations for advanced research, we may need to work on the development of new technology such as tumor xenograft techniques. In conclusion, we need to continue to seek better ways to sample and process less invasively obtained needle-biopsied material for diagnosis and molecular analysis for improved patient care. Ultrasonography-Guided Transbronchial Needle Aspiration and MicroRNA: Return to the Past?The Annals of Thoracic SurgeryVol. 96Issue 1PreviewStarting from the early 1990s, the number of articles on gene expression in lung cancer has constantly increased each year and now exceeds more than 25,000. Discovered 10 years ago, microRNAs are minute noncoding RNA genes that represent a system able to modulate gene expression [1]. It is estimated that the human genome contains more than one thousand microRNA genes, which regulate at least a third of protein-encoding genes. A single microRNA can modulate levels of several targets, which frequently belong to the same biological pathway; consequently, the manipulation of a single microRNA could affect several signaling processes in tumor biology. Full-Text PDF