During the staging process of lung cancer, accurate mediastinal lymph node staging is one of the important factors which affect patient management. The purpose of the current study was to evaluate the usefulness of direct real-time endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for staging and diagnosis of lung cancer in patients with mediastinal lymph nodes suspected of malignancy and to assess the impact of this method in patient management. One hundred and eight patients with mediastinal lymph nodes with known or suspected lung cancer were included. The convex probe EBUS integrated with a convex scanning probe on its tip was used in all cases. Final diagnosis was based on cytology, surgical results, and/or clinical follow-up. In 105 patients, EBUS-TBNA was successfully performed to obtain samples from 163 lymph nodes. With respect to the correct prediction of lymph node stage, EBUS-TBNA had a sensitivity of 94.6%, specificity of 100%, positive predictive value of 100%, negative predictive value of 89.5%, and diagnostic accuracy rate of 96.3%. In the 20 suspected lung cancer cases, mediastinal lymph node was used for tissue diagnosis of malignancy as well as staging. As a result of EBUS-TBNA, 29 mediastinoscopies, 8 thoracotomies, 4 thoracoscopies, and 9 CT-guided PCNB were avoided. The procedure was uneventful without complications. EBUS-TBNA is a safe and sensitive method for lymph node staging in patients with lung cancer. It spares invasive staging procedures which has a major impact on patient management.