Pulmonologist-performed Ultrasound-guided Transthoracic Biopsy of Pleural-based Lung Masses: Diagnostic Yield and Safety, a Retrospective Study

OBJECTIVE: Ultrasound-guided transthoracic lung biopsy is a well-established, minimally invasive technique for evaluating peripheral and pleural-based lung lesions. Its use by trained pulmonologists has expanded in recent years; however, evidence from tuberculosis-endemic regions remains limited. This study aimed to assess the diagnostic yield and safety profile of pulmonologist-performed ultrasound-guided transthoracic biopsy of pleural-based lung masses. MATERIAL AND METHODS: This retrospective study included patients who underwent ultrasound-guided transthoracic biopsy of pleural-based lung lesions. Of 129 eligible patients, 6 did not undergo the procedure, and 7 were excluded because histopathology was unavailable, resulting in 116 patients included in the final analysis. All biopsies were performed by pulmonologists who had formal interventional pulmonology training or who were under direct supervision. Diagnostic yield, histopathological findings, and procedure-related complications were evaluated. RESULTS: The overall diagnostic yield was 97.4% (113/116). Malignancy was identified in 72.4% of patients, with adenocarcinoma (39.7%) as the most frequent subtype, followed by squamous cell carcinoma (15.5%). Tuberculosis was diagnosed in 9.5% of cases, while 2.6% remained inconclusive. Notably, 29.3% of patients were already receiving anti-tuberculosis therapy at presentation. The overall complication rate was 10.3%. Pneumothorax occurred in 3.4% of patients, and minor hemoptysis occurred in 2.6%; all events were managed conservatively. No procedure-related mortality was recorded. CONCLUSION: Pulmonologist-performed ultrasound-guided transthoracic biopsy of pleural-based lung lesions yields high diagnostic yield with a low complication rate when conducted by formally trained operators. In tuberculosis-endemic settings, histopathological confirmation is critical to differentiate malignancy from infectious etiologies. Structured interventional pulmonology training may further optimize procedural outcomes and enhance patient safety.