Abstract: Objective To compare the diagnostic performance and safety profiles between ultrasound-guided core needle biopsy (CNB) and fine-needle aspiration (FNA) for infraclavicular lymph node biopsy, and establish a stratified decision-making framework based on anatomical characteristics and patient risk factors. Methods This retrospective study analyzed 561 consecutive cases of infraclavicular lymph node biopsies. Patients were stratified into CNB group (n=282, lymph node transverse diameter ≥1.0 cm) and FNA group (n=279, transverse diameter ＜1.0 cm or with advanced age/coagulopathy). The diagnostic efficacy and complications between two groups were collected and compared. Patients were divided into 2 groups based on the occurrence of complications, and multivariate Logistic regression analysis was performed to identify risk factors for complications. Results The diagnostic accuracy (98.20% vs. 93.50%), sensitivity (96.90% vs. 90.30%) and negative predictive value(96.00% vs.83.80%) of CNB group were significantly higher than those of the FNA group (P＜0.01). The incidence of complications such as puncture site bleeding and mild pain in the CNB group was 28 cases (9.93%), significantly higher than the 8 cases (2.87%) in the FNA group (χ²=11.646, P＜0.01). Age, puncture method and longitudinal diameter of the lymph node were independent influencing factors for complications after subclavian lymph node biopsy (P＜0.05). Conclusions For subclavian lymph node biopsy, CNB demonstrates superior diagnostic performance but carries a higher risk, while FNA is safer but may lead to missed diagnoses. Clinical decisions should prioritize precision individualized puncture based on lymph node size and patient-specific factors, such as age, coagulation abnormalities.

Key words: subclavian lymph node biopsy, diagnostic efficacy, core needle biopsy, fine-needle aspiration