The article discusses a study which examined the adequacy of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) in the absence of rapid on site evaluation (ROSE) by a cytopathologist at a high volume tertiary care center. Particular focus is given to the EUS-FNA procedure, as well as the slide preparation measures. Also discussed are role of the gastroenterologist in the process and adequacy rate of lymph node lesions.