Today endosonography in form of endobronchial (EBUS) and endoesophageal ultrasound (EUS) is a routine adjunct to endoscopy in many pulmonary centers. Three different techniques are available and can improve the diagnosing and staging in patients with lung cancer. The clinical application and the diagnostic benefit have been established in a lot of studies compared with conventional radiologic methods and other diagnostic procedures. The role of endosonography is expected to grow in the near future as an important tool. Especially the approaches with EUS-fine needle aspiration (EUS-FNA) and/or EBUS controlled transbronchial needle aspiration (EBUS-TBNA) may be able to replace more invasive methods like mediastinoscopy for evaluating patients with lung cancer.