BACKGROUND AND AIM: Subsolid pulmonary nodules (SSNs), encompassing pure ground-glass nodules (pGGNs) and part-solid nodules (PSNs), may represent a spectrum of pulmonary adenocarcinoma. Accurate preoperative diagnosis is essential to guide treatment decisions and avoid unnecessary surgeries. This study aimed to evaluate the diagnostic performance of CT-guided transthoracic core needle biopsy (CT-TNB) in SSNs, with correlation to final surgical pathology.

METHODS: This retrospective cohort study included 41 SSNs from 40 patients who underwent CT-TNB followed by surgical resection between 2012 and 2022. Radiological and histopathological characteristics were evaluated. Descriptive statistics and diagnostic performance metrics were calculated using Python.

RESULTS: Of the 41 SSNs, 13 (31.7%) were pGGNs and 28 (68.3%) were PSNs. CT-TNB diagnosed 36 nodules (87.8%) as adenocarcinoma, 4 (9.8%) as atypical epithelial cells, and 1 (2.4%) as benign pathology. Final pathology revealed 28 (68.3%) invasive adenocarcinoma (IA), 10 (24.4%) minimally invasive adenocarcinoma (MIA), 1 adenocarcinoma in situ, 1 atypical adenomatous hyperplasia, and 1 breast cancer metastasis. CT-TNB had 97.6% sensitivity and 100% PPV for malignancy. For invasive carcinoma (MIA or IA), sensitivity was 94.7% with 100% specificity and PPV.

CONCLUSIONS: CT-TNB demonstrates high diagnostic accuracy for SSNs and reliably correlates with postoperative pathology. It remains a valuable tool for preoperative assessment when performed by experienced teams using core needle techniques.