Peripheral localization and lack of symptoms are reasons why it is difficult to establish the diagnosis of peripheral pulmonary lesions commonly of malignant nature. Therefore thoracotomy often represents a diagnostic and therapeutic method at the same time. There is a need to define an adequate and optimal diagnostic approach to these lesions in order to establish their etiology, if possible, at low costs.This retrospective study included 50 patients with peripheral solitary pulmonary lesions (PSPL) who underwent thoracotomy at the Institute of Lung Diseases in Sremska Kamenica. In all patients both bronchoscopy and transthoracic puncture were performed prior to surgery. Having evaluated the diagnostic procedures, their proper sequence has then been applied in the prospective group of another 50 patients admitted to the Institute for similar lesions.In the retrospective group the etiology of PSPL was established by bronchoscopy in 4% and using transthoracic puncture in 58% of patients, with sensitivity, specificity and accuracy of 78.78%, 100% and 85.1%, respectively. In the prospective group, transthoracic puncture (TTP) provided the final diagnosis in 70% of patients, with 86.2% sensitivity, 100% specificity and 90% accuracy.Transthoracic puncture is a method of choice in preoperative diagnostics of solitary peripheral pulmonary lesions, quite like thoracotomy in cases where applied diagnostic procedures were inefficient.