Lung cancer (LC) represents the leading cause of cancer-related mortality worldwide, with most of the cases being still diagnosed in advanced stages. Recently published data estimates an increase of LC deaths worldwide from 1.6 million in 2012 to 3 million in 2035. In this context, ultrasonography (US) aspires to become the method of choice that can offer essential information concerning subpleural LC. Therefore, it is an urgent need for an objective evaluation of the role of US and US-guided biopsies as an accurate diagnosis method, as until now large studies to assess this have been seldom performed. Our main aim was to perform a review over the use of US and US-guided biopsy in the assessment of LC, and our second aim was to illustrate how US is a valuable tool in the approach of patients with LC. We also compared the advantages and disadvantages of different types of biopsy needles. Other non-invasive applications of US (contrast-enhanced US and elastography) and their usefulness for LC were also evaluated. Though transthoracic US is today underused for lung cancer diagnosis, it offers multiple advantages that seem extremely useful for the efficient management of such tumours.