Objective?To evaluate the diagnostic value of endobronchial ultrasound combine with rapid on-site evaluation of cytology (C-ROSE) of bronchial brushing (BB) for pulmonary peripheral lesions. Methods?Through the ultrasonic probe into the lesion, got the best images of ultrasound images and the best location, then exit the ultrasonic probe. According to the pathways of the ultrasonic probe, bronchial brushing was performed. Bronchial brushing was terminated when diagnostic C-ROSE specimens were characterised as those clearly demonstrating the typical cytological features of malignancy. Non-diagnostic C-ROSE resulted in further bronchoscopic sampling, including transbronchial lung biopsy and/or sampling from different locations. Blind biopsy was performed with biopsy forceps through pathways of the ultrasonic probe after brushing in every checked part. Results?Malignant diagnosis was 43 out of 59 patients, the sensitivity of transbronchial lung biopsy and bronchial brushing were 55.8 % (24/43), and 81.4 % (35/43). The combining bronchial brushing and biopsy improved diagnostic sensitivity. The false-positive the sensitivity of C-ROSE was 0.0 % and 74.4 % (32/43), C-ROSE has good concordance with bronchial brushing cytology in the diagnosis of pulmonary peripheral lesions (Kappa value was 0.902, P <0.001). The diagnostic yields of bronchial brushing and brush combining with biopsy in peripheral lung cancer were 68.8% (11/16) and 75.0 % (12/16) on lesions with <30 mm diameter and were 88.9 % (11/16) and 92.6 % (12/16) on lesions with ≥30 mm diameter, no statistically significant differences were found (P > 0.05). The diagnostic yields between bronchial brushing and bronchial brushing combining with biopsy is also no statistically significant differences in anyone lobes (P >0.05). Procedure times and brushing times were significantly shorter (lesser) for procedures when rapid on-site examinations demonstrated malignancy compared to those where rapid on-site examination was non-diagnostic (20.80 ± 7.93) min versus (26.60 ± 7.22) min, respectively; (P <0.05), (1.61 ± 0.90) times versus (2.35±0.69) times; (P <0.05). 5.1 % (3/59) of the tumor patients were found with redirection of sampling by result of C-ROSE. Conclusion? Endobronchial ultrasound combine with rapid on-site evaluation of bronchial brushing is effective for pulmonary peripheral lesions. It can reduce procedure times, brushing times and complications, when rapid on-site examinations demonstrated malignancy.