Peripheral lung lesions, often indicative of various diseases, require accurate diagnosis for appropriate management. Ultrasound (US)-guided tru-cut biopsy offers a minimally invasive method for diagnosing these lesions. This study aims to evaluate the role of US-guided tru-cut biopsy in diagnosing peripheral lung lesions. Methods: This prospective study included 60 patients with imaging-confirmed peripheral lung masses, admitted to Benha University Hospitals between January and December 2023. All patients underwent US-guided tru-cut biopsy using a 16-gauge needle. Clinical and imaging data were collected, and histopathological analysis was performed. Results: The most common lesion sites were the right lower lobe (26.7%) and left upper lobe (23.3%). Bronchogenic carcinoma was the most prevalent pathology (66.6%), followed by malignant metastatic papillary adenocarcinoma (16.7%). Lesions larger than 5 cm were observed in 61.7% of cases. Solid masses with smooth margins were found in 43.3%. Two core biopsies were obtained in 96.7%, with 3.3% requiring a single core due to complications. Re-biopsy was needed in 6.7% of cases. Hydro pneumothorax occurred in 3.3%, requiring chest tube insertion. A significant association was found between core size and the need for re-biopsy (p=0.003), and pleural effusion and lung collapse were linked to complications (p=0.010). Conclusion: US-guided tru-cut biopsy is an effective, minimally invasive method for diagnosing peripheral lung lesions with minimal complications. Larger studies are needed to confirm these findings and explore its broader application.