Background <p>Accurate mediastinal staging is essential for treatment planning and prognostic assessment in patients with extrapulmonary malignancies. Endobronchial ultrasonography (EBUS) has emerged as a minimally invasive modality for mediastinal evaluation; however, evidence regarding its diagnostic performance in extrapulmonary malignancies remains limited.</p> Methods <p>Patients with known extrapulmonary malignancies who underwent EBUS for mediastinal staging were retrospectively analyzed. Demographic characteristics, radiological findings, sampled lymph node stations, and pathological results were evaluated. Factors potentially associated with malignant mediastinal involvement were assessed.</p> Results <p>EBUS enabled successful sampling of mediastinal and hilar lymph nodes across multiple stations. Malignant involvement was identified in a subset of patients, while benign etiologies—including reactive and granulomatous lymphadenopathy—accounted for the majority of cases. Increased lymph node diameter was associated with malignancy, whereas primary tumor type and the number of sampled lymph nodes were not independent predictors of malignant pathology.</p> Conclusions <p>EBUS appears to be a safe and reliable tool for mediastinal staging in patients with extrapulmonary malignancies. Its minimally invasive nature and diagnostic performance support its use as a first-line modality, potentially reducing the need for confirmatory mediastinoscopy in selected patients.</p>