• The objective of this research is to determine the accuracy of different types of lung transthoracal needle aspiration (TTNA) i.e. jabbing-then-suction, suction-with-jabbing, and suction-only TTNA in patients with suspected lung cancer.
• Researchers will compare these techniques to determine whether there are any quality differences in the obtained tumor samples

During hospitalization for diagnostic testing, suspected lung cancer patients will undergo a transthoracic biopsy using three TTNA techniques, and core needle biopsy as the gold standard. The biopsy is performed in the operating room under local anesthesia and under the supervision of an anesthesiologist. The biopsy techniques used are routine procedures and therefore not as a new method. After the biopsy is completed, the patient is observed for at least 24 hours to observe potential complications.

Inclusion Criteria:

• Patients with suspected lung cancer who will undergo diagnostic testing using ultrasound-guided TTNA of the lung with cell block and core biopsy.
• Patients aged 18-75 years.
• The tumor is located peripherally, attached to the chest wall.

Exclusion Criteria:

• Patient refuses lung biopsy
• Non-cooperative patient
• Patient with respiratory failure, on positive pressure ventilation
• Severe pulmonary emphysema
• Contralateral pneumonectomy
• Advanced pulmonary fibrosis
• Platelet count <100,000/mm3 and international normalized ratio (INR) >1.4

Individual participant data (IPD) collected during the trial reported in the article will be shared, after deidentification.

IPD and supporting information will be available immediately following publication, without end date.

Requestors who provide a methodologically sound proposal can access the our IPD data. Proposals should be directed to roihan.iqbal@gmail.com

The biopsy results, in a form of 20 cc syringe and slide containing the patient's tissue sample, will be labeled with a code by pulmonologist that will be blinded to the pathologist. The pathologist will then assess the adequacy of the cell count for molecular examination, evaluate the histopathological and cytopathological findings. Statisticians who will process the data are unaware of the allocation of each research item.