Primary lung cancer is an increasing health issue worldwide, with an ever-growing incidence due to various risk factors dispersed in all settings of modern society. Late discovery and poor survival rates for patients that do not qualify for surgical treatments greatly decrease overall mortality. Imaging methods remain powerful tools for early detection; however, molecular profiling is currently required for better understanding treatment options and for developing novel agents. Most procedures that are associated with tissue collection are invasive and, if performed in suboptimal conditions, may lead to morbidity and mortality. The need for better optical biopsy tools has thus arisen, directing further tissue collection and minimizing the chance of misdiagnosis. A series of methods have been proposed, including optical coherence tomography, narrow band imaging or autofluorescence. Lately, a novel in vivo tool for rapid and non-invasive microscopy gained traction - probe based confocal laser endomicroscopy became available in an increased number of referral centers worldwide. Miniaturization and the use of optical fibers allowed for the development of a dedicated device for pulmonary applications; lung cancer diagnosis and characterization are key issues targeted by this novel technology. We present here recent advancements in the field of optical biopsy of lung tissue, with a focus on emerging technologies and their involvement in cancer diagnostics and future therapeutic options.