Maximizing Diagnostic Accuracy: Core Needle Biopsy versus Fine-Needle Aspiration in Peripheral Lung Lesions

<bold>Objectives:</bold> Our study compares ultrasound-guided Fine-needle aspiration biopsy with cell block(FNB) to Core needle biopsy(CNB) in peripheral lung lesions. Primary objectives include assessing diagnostic yield in benign and malignant lesions, sensitivity, and specificity. Secondary objectives include procedure times, complications, and molecular testing. <bold>Methods:</bold> In a prospective study, 25 patients with peripheral lung lesions underwent ultrasound examination using color Doppler and strain elastography by a trained pulmonologist. Following patient consent, real-time ultrasound-guided FNAB with a 22G needle for cell block preparation was performed, followed by ultrasound-guided CNB with an 18G tru-cut needle. Ultrasound was used to check for complications. Samples were coded and processed separately by a blinded pathologist. TTF-1 and Napsin A, P63, and CK5/6 were tested for all samples, with EGFR conducted for TTF-1 and Napsin A positive specimens. <bold>Results:</bold> FNAB: 66% sensitivity, NPV 11% accuracy 68%. CNB: 95% sensitivity, NPV 75% accuracy 96%. No significant difference in complication rates. <bold>Conclusion:</bold> CNB emerges as the prime selection for ultrasound-guided biopsies targeting peripheral lung lesions, owing to its superior diagnostic yield and negligible complication rates. FNAB remains a viable alternative, particularly in cases where lesions are excessively vascular or too diminutive for CNB <fig><object-id>erj;64/suppl_68/PA3438/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>