【Abstract】 Objective To explore the value of transbronchoscopic needle aspiration (TBNA) in the diagnosis of mediastinal or hilar lymphadenopathy. Methods From December 2016 to December 2017, 70 patients with mediastinal or hilar lymphadenopathy and no obvious external pressure or mass in lumen were selected. All patients underwent needle aspiration biopsy of mediastinal lymph nodes and were sent for examination after smear. After completion of TBNA, brush examination was performed at the puncture point. If congestion and edema were found and local mucosa thickening was found, biopsy was performed. The diagnostic rate of TBNA and mucosal biopsy complicated with brush mucosal examination. The safety and effectiveness of TBNA and the difference of TBNA diagnosis rate in different lymph nodes were evaluated. Among the 70 patients, 17 cases were small cell carcinoma, 14 cases were not classified, 6 cases were adenocarcinoma and 5 cases were squamous carcinoma. The diagnosis rate of mucosal biopsy complicated with brush mucosal examination was 21.43% (15 cases). The diagnosis rate of TBNA was significantly higher than t mucosal biopsy complicated with brush mucosal examination (P＜0.05). The diagnostic rate of TBNA in patients with lymph node diameter ＞2cm was significantly higher than those with lymph node diameter ≤ 2cm (P＜0.05). The diagnostic rate of TBNA in patients with subcarinal lymph nodes was significantly higher than that in patients without subcarinal lymph nodes (P＜0.05). There was little bleeding in the puncture site of 41 patients, and more bleeding in 5 patients, but no special hemostasis and bleeding stopped by itself. No mediastinal emphysema, bleeding, mediastinal infection, pneumothorax and other complications occurred. There was no significant difference in adverse reactions and complications of each group (P＞0.05).Conclusion TBNA plays an important role in the etiological diagnosis of mediastinal or hilar lymphadenopathy, especially in patients with lymphadenopathy greater than 2cm in diameter and subcarinal lymphadenopathy.