We reviewed the diagnostic accuracy and complication rates of transthoracic needle biopsy (TNB) with an automated 18-gauge core biopsy needle and gun, using either fluoroscopic or CT guidance. One hundred six lesions were biopsied in 103 patients between 1992 and 1998. Hard-copy images, imaging reports, pathology reports and clinical notes were reviewed. In 3 patients it was not possible to establish the lesion as either malignant or benign from the available follow-up, so these were removed from the analysis of diagnostic accuracy. Adequate samples for histological diagnosis were obtained in 104 of 106 (98%) biopsies. There were 75 of 85 (88%) true-positive core biopsies for malignant lesions and a specific cell type was identified in 70 of 85 (82%) cases. A specific histological diagnosis was obtained in 12 of 18 (66%) biopsies. There was a 19% rate of pneumothorax with only 2.4% requiring drainage. Minor haemoptysis occurred in 3.8% of procedures. The TNB technique with an automated core biopsy needle provides a high level of diagnostic accuracy, effectively distinguishes cell type in malignancy and provides a definite diagnosis in benign disease more frequently than fine needle aspiration (FNA). There is no increased complication rate compared with FNA.

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