Diagnostic Yield and Safety of Pulmonologist-Performed Ultrasound-Guided Transthoracic Core Biopsy: A Seven-Year Cohort Study

Background/Objectives: Given rising lung cancer incidence and limited data on pulmonologist-performed ultrasound-guided transthoracic core biopsy (US-TTCB), in this study, we evaluated diagnostic yield and safety for pleural or pulmonary lung masses, using Clavien–Dindo classification to standardize complication reporting. Methods: We retrospectively reviewed single-center pulmonologist-performed US-TTCB using a MEDONE biopsy gun with a 16 G/18 G Tru-Cut needle between January 2019 and December 2025. The primary endpoints were diagnostic yield, defined as specific malignant or benign histology, and complication rate. Non-diagnostic results were assessed using available clinical/imaging follow-up. Univariate analyses screened candidate correlates, and a prespecified computer tomography (CT)-completed subanalysis (n = 67) used multivariable logistic regression and receiver operating characteristic (ROC) analysis to assess CT lesion size discrimination. Results: Diagnostic yield was 84.2% (202/240); complications occurred in 12.1% (29/240), including one Clavien–Dindo Grade III event (0.4%). In the CT-completed subset (n = 67), diagnostic yield was independently associated with CT lesion size (aOR 1.03/mm, 95% CI 1.00–1.05; p = 0.022) and Chronic Obstructive Pulmonary Disease (COPD) (aOR 2.30, 95% CI 1.06–4.96; p = 0.034); CT lesion size showed an area under the curve (AUC) of 0.717 for predicting yield. Diagnostic yield remained stable over time (84.2% in first vs. second half; p = 1.00), with no association between case order and yield (OR 0.999; p = 0.64). Conclusions: US-TTCB of pleural/pulmonary masses achieved a high diagnostic yield with minimal major complications. Large CT dimension and COPD were associated with higher diagnostic success, and CT size provided fair discrimination for predicting yield; findings should be interpreted in the context of the retrospective single-center design and the restricted CT-completed subset.