Bronchoscopy has been in clinical use for a long time with an excellent safety record. Unfortunately, the yield of bronchoscopic procedures for staging mediastinal lymph nodes as well as for the biopsy of peripheral lesions with conventional techniques has been disappointing. Transbronchial biopsy as well as transbronchial needle aspiration are generally performed without direct visualization, which partially explains this problem. The advent of endobronchial ultrasound has dramatically changed the environment, and, if used for guidance of transbronchial biopsy, lymph nodes can be reliable samples challenging the notion that mediastinoscopy should be the mediastinal staging procedure of choice. This article reviews technological background, application, and results of endobronchial ultrasound added to diagnostic bronchoscopy in the diagnosis and staging of patients with lung cancer.