Abstract Background: Lung cavity is not a specific radiological finding, Computed Tomography (CT)-guided lung biopsy is a reliable method of diagnosing lung lesions cytologically, Fine Needle Aspiration Biopsy (FNAB) is considered as a relatively safe procedure & accurate procedure with less complication rate. Taking in consideration the serious complication of CT guided lung biopsy and the need for obtaining adequate sample to get benefit of the recent success in targeted therapy of non-small cell lung carcinoma and lung adenocarcinoma. Aim of Study: The aim of this study is to evaluate the accuracy of CT guided fine needle biopsy in cavitary pulmo-nary lesions and to establish technical parameters to bridge the gap between diagnostic accuracy and adequacy of CT guided fine needle biopsy in cavitary pulmonary lesions. Patients and Methods: 52 patients with lung cavities were included (29 male and 23 female) with age (mean ±  SD) of 56±12.4 years. Sampling of the maximal wall thickness of the lesion. Aspirated specimens were submitted on positively charged glass slides and the remainder fixed in 95% alcohol. A pathologist performed rapid an onsite preliminary diagnosis and material triage. In all 52 cases Fine Needle Aspirations (FNA) for cytology were obtained, Samples for microbiology were obtained in 10 cases. The results categorized into 4 diagnostic groups malignant, Benign specific, Benign nonspe-cific, and non diagnostic. Results: Histological examinations revealed over all sensitivity (39/41) and specificity (9/10), of CT guided FNAB for diagnosing the malignancy. In 6 cases, molecular studies were requested, positively charged glass slides and cell block paraffin-embedded tissue was used in all cases in 66.6% of the cases all requested molecular tests could be done, in 16.7% the material were sufficient for only some studies while in 16.7% there was no sufficient material for any test. In some cases Epidermal Growth Factor Receptor [EGFR], Anaplastic Lymphoma Kinase [ALK] testing were requested and successfully per-formed.
Conclusion: CT-guided fine needle biopsy of cavitary lung lesions combined with rapid on site pathological evalu-ation increase the accuracy and bridge the gap between accuracy and adequacy to provide adequate tissue for molecular testing from the small size sample.