Percutaneous needle biopsy of thoracic pathology has gained popularity showing a good accuracy with a less invasive procedure. The purpose of the paper is to present our experience of ultrasound and CT guided thoracic biopsy approaches regarding procedure effectiveness and complications. 398 Image guided percutaneal core biopsy procedures of thoracic pathology (mediastinum, lung, pleura, bone and soft tissue) has been performed to 380 (95.5%) patients. In 18 (4.5%) cases the repeated biopsy procedure has been performed as the obtained specimen appeared to be non-informative. All repeated procedures were needed when the target size was above 2-5 or >5 cm using CT guided biopsy and it was due to tumor necrosis. No complications were detected after US guided procedures; No repeated procedures were needed as the first one enable to obtain the informative biopsy specimen. Procedure related complication were detected in 48 (12.1% of all procedures) CT guided cases in total; among them in 35 (8.8%) cases pneumothorax, in 5 (1.3%) hemothorax and in 7(1.8%) hemophtisis was detected. Slight bleeding along the needle pass with the hematoma formation was detected in 1 (0.2%) case for soft tissue lesion. 47 (11.9%) complications were detected on transpulmonary approach cases and only 1 (hematoma formation - 0.2%) - on extrapulmonary approach. Percutaneous image-guided core biopsy of thoracic lesions is an accurate and safe procedure, which enables to get the tissue material from all thoracic compartments. The vast majority of complications should be expected on transpulmonary approach cases.