Diagnosing unclear lymphadenopathy such as lymph node metastasis has an enormous impact on the treatment of neoplastic diseases. Therefore, the aim of treatment usually switches from cure to palliation. Numerous other diseases are accompanied by lymphadenopathy, including benign conditions such as infections and inflammatory disease. 1 Hence, sampling of the target node is often required to unveil the underlying diagnosis and to enable adequate clinical management. 2 Intrathoracic or intraabdominal lymphadenopathies are clinically challenging because the nodes are difficult to sample using non-invasive techniques. Therefore, invasive methods such as mediastinoscopy or laparotomy are needed but are associated with risks. 3 A mini-invasive method such as endosonography (EUS) is an alternative approach in such scenarios. 4 Endosonographic characteristics of malignant lymph nodes include large size, hypoechogenicity, distinct border, round shape, and high tissue stiffness on elastography. 5,6 Neverthe