PURPOSE: To evaluate the usefulness of real-time ultrasound-guided biopsy as an aid in diagnosing pleural attached lung lesions. MATERIALS AND METHODS: Over a 2-year period (March 1992 through February 1994), 52 US-guided diagnostic biopsies were performed in 50 patients with peripheral lung lesions in contact with chest wall. 15 cases were performed with gun biospy and 37 cases with fine needles. Final diagnosis was confirmed by surgery and clinical follow-up. RESULTS: In 44 of 52 cases(84.6%), we obtained histologic or cytologic material by US-guided biopsy. Diagnostic accuracy and tissue type specific accuracy for malignancy were 83.9%(26/31) and 67.7% (21/31), respectively. Eighteen case% were reported to be benign and one of them was proven to be metastatic lesion. We could not find any complications such as hemoptysis or pneumothorax. CONCLUSION: Ultrasound-guided biopsy is a simple, safe and accurate diagnostic procedure for evaluation of peripheral lung lesion attached to the pleura.