Introduction: Biopsy procedures of intra-parenchymal lesions are divided into needle biopsy (stereotactic or frameless) or navigation-guided endoscopic biopsy.

Methods: We retrospectively reviewed 36 consecutive patients with intra-parenchymal lesions who underwent biopsy at our institution. Fourteen patients underwent navigation-guided endoscopic biopsy (endoscopic group) and 22 patients underwent needle biopsy (needle group). Rates of pathological diagnosis and postoperative hemorrhage were compared between groups and analyzed using Fisher's exact test. Probability values of <0.05 were considered statistically significant.

Results: Pathological diagnostic rates were 100% (14/14) for the endoscopic group and 96% (21/22) for the needle group, showing no significant difference. The postoperative hemorrhage rate was 7.1% (1/14) in the endoscopic group and 27.3% (6/22) in the needle group (p=0.21). Symptomatic postoperative hemorrhage was seen in 0% (0/14) of the endoscopic group and 18.2% (4/22) in the needle group (p=0.14).

Conclusion: Both needle and endoscopic biopsies are accurate procedures with high rates of pathological diagnosis. Postoperative hemorrhage tended to be less frequent with endoscopic biopsy than with needle biopsy. Here, we described procedure selection and ingenuity of accurate and safe biopsy at our institution.

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