Objective To explore the diagnostic value of video assisted mediastinoscopy (VAM) in mediastinal mass and lung cancer.Methods A total of 40 patients with high suspicion of mediastinal mass and 40 patients with high suspicion of lung cancer who were admitted to our hospital between February 2016 and June 2019 were enrolled in the study.All subjects underwent VAM and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Taking the pathological results of paraffin sections as the golden standard, the accuracy rates, sensitivities and specificities of the two surgeries in the diagnosis of mediastinal mass and lung cancer were calculated, the incidence rate of complications was statistically analyzed.Results The sensitivity and accuracy of VAM in the diagnosis of mediastinal mass and lung cancer were higher than those of EBUS-TBNA, the differences were statistically significant (P<0.05).There were no significant difference in the incidence rates of hoarseness, pneumothorax, infection or massive hemorrhage between the two examination methods (P>0.05).Conclusion The sensitivity and accuracy of VAM are higher than those of EBUS-TBNA in the diagnosis of mediastinal mass and lung cancer, without increasing the risk of complications, and it is worthy of clinical promotion.