In this issue of CHEST (see page 1887), Kurimoto and colleagues have provided further evidence toward establishing endobronchial ultrasound (EBUS) as a critical diagnostic tool during bronchoscopy. Utilizing EBUS images of peripheral pulmonary lesions, the authors correlated histopathologic findings from surgical specimens to develop a classification system of sonographic images to distinguish benign from malignant lesions. This system of three classes and six subclasses details how patterns of differing echoes reflect vascular, bronchial, and alveolar abnormalities that suggest the histology of the peripheral pulmonary lesion. In fact, those demonstrating a homogenous pattern (type 1) were overwhelmingly benign (92%), whereas hyperechoic dots or a heterogeneous pattern (types 2 and 3, respectively) portended malignancy in 98 of 99 cases (99%). Also of note is that this study was performed during routine flexible bronchoscopy employing topical anesthesia, with the use of ultrasound requiring an average of only 8.38 min.