Accurate mediastinal staging is important, and many imaging and invasive mediastinal staging tests are available. The data are confusing because patients with particular characteristics (ie, node size or location) are selected for different staging procedures. An approach is presented that integrates the various available tests and selects those tests with the highest ability to answer the question at hand. The goal is to maximize efficiency by enhancing staging accuracy while minimizing the number of tests each patient is subjected to.