Objective To analyze the value of lung biopsy combined with cytological rapid on-site evaluation（C-ROSE） in the diagnosis of lung shadowing. Methods One hundred and sixty-eight patients with lung shadowing admitted to a hospital in Jiaozuo from January 2019 to March 2021 were selected for the study. All patients underwent ultrasound-guided percutaneous puncture lung biopsy

and they were divided into the C-ROSE group（84 cases） and the conventional cytology group（84 cases） according to whether C-ROSE was used

and the histological pathology results were used as the gold standard to compare the diagnostic results of lung shadowing as well as the number of punctures

surgical operation time

secondary puncture biopsy rate

and complication rate in the 2 groups. Results The results of histological pathology showed that there were 70 patients with malignant tumors and 14 patients with benign lesions in the C-ROSE group

and 68 patients with malignant tumors and 16 patients with benign lesions in the conventional cytology group. The sensitivity of patients in the C-ROSE group for the diagnosis of lung shadowing was 94.29%

the specificity was 78.57%

the accuracy was 91.67%

and the Kappa value was 0.708

with high agreement with the gold standard. The sensitivity of patients in the conventional cytology group for the diagnosis of lung shadowing was 79.41%

the specificity was 75.00%

the accuracy was 78.57%

and the Kappa value was 0.439

which were in moderate agreement with the gold standard. The number of punctures and the rate of secondary puncture biopsies in the C-ROSE group were lower than those in the conventional cytology group

and the differences were statistically significant（P

<

0.05）; the operation time in the C-ROSE group was longer than that in the conventional cytology group

and the difference was statistically significant（P

<

0.05）. The complication rate of patients in C-ROSE group during treatment was 4.76%

which was lower than that of 14.29% in conventional cytology group

and the difference was statistically significant（χ

=

4.421

P=0.035）. Conclusion Lung biopsy combined with C-ROSE can improve the diagnostic efficacy and reduce the number of punctures

secondary puncture biopsy rate and complication rate in patients with lung shadowing.