Ultrasound- versus CT-guided Biopsy of Pleural-contact Pulmonary Lesions: A Comparative Analysis of Diagnostic Performance and Procedural Complications

OBJECTIVE: To compare the diagnostic performance and complication profiles of ultrasound (US)-guided and computed tomography (CT)-guided biopsy in pleural-contact pulmonary lesions and to evaluate technical factors associated with pneumothorax development after CT-guided biopsy. MATERIAL AND METHODS: This retrospective single-center study included 197 patients with pleural-contact pulmonary lesions who underwent image-guided transthoracic core needle biopsy between January 2023 and March 2026. Of these, 123 underwent CT-guided biopsies and 74 underwent US-guided biopsies. Diagnostic adequacy, diagnostic accuracy, and procedure-related complications were compared between the groups. Factors associated with pneumothorax after CT-guided biopsy were evaluated using univariate and multivariable logistic regression analyses. RESULTS: = 0.031); however, no independent predictor was identified in multivariable analysis. CONCLUSION: US-guided biopsy of pleural-contact pulmonary lesions demonstrated diagnostic adequacy and diagnostic accuracy comparable to CT-guided biopsy and was associated with lower pneumothorax and chest tube placement rates in this retrospective cohort. When an adequate acoustic window and pleural contact are present, US guidance may be a safe and effective alternative biopsy approach for appropriately selected pleural-contact pulmonary lesions.