Background: During endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), aspirated and tissue coagulum clot are obtained from patients. The objective of this study was to compare the combined diagnostic sensitivity of aspirate cytology and tissue coagulum clot histology with each method alone. Methods: Between May 2009 ~ May 2014, EBUS-TBNA database was analyzed retrospectively. The cytopathological examination was based on aspirtate cytology and tissue coagulum clot histology. Results: A total of 3107 lymph nodes were evaluated in 1367 patients with primary lung cancer. A total of 1207 lymph node was confirmed as malignant lymph nodes. The sensitivity was 94.5% (1093/1157) for histology and 83.8% (970/1157) for cytology (p<0.0001). The combined diagnostic sensitivity of histology and cytology was 100 % (1207/1207). 5.5% (64/1157) of malignant lymph node was negative histology / positive cytology and 16.2% (187/1157) of malignant lymph node was negative cytology / positive histology. This negative histology/positive cytology group showed significantly shorter short axis diameter of lymph node (p=0.0049) and less needle passes per lymph nodes (p=0.0015) compared with other groups. Conclusions: The combination of cytology and histology can increase the diagnostic sensitivity of EBUS-TBNA. Aspirate cytology and tissue coagulum clot histology should be included in cytopathological evaluation together.