Accurate, safe and fast mediastinal staging in lung cancer is pivotal to identifying patients who will benefit from surgical treatment. Imaging techniques have insufficient diagnostic power and in most cases do not abolish the need for invasive staging. A literature review using the search words "endoscopic ultrasound (EUS) and lung cancer" in PubMed was conducted. Invasive procedures (mediastinoscopy, thoracoscopy/-tomy) are the gold standard. The specificity of EUS was between 97 and 100%, and sensitivity 90 to 92%. The sensitivity was lower in studies published before 2000, and in computed tomography (CT) node-negative patients. EUS is the cheapest procedure in mediastinal staging. EUS results were associated with survival and reduced the need for invasive procedures to approximately 50% with a complication rate of approximately 0%. EUS is safe, accurate, and has a huge impact on management of mediastinal staging in lung cancer.