Abstract: Objective To investigate the value of coaxial needle in Cone-Beam Computed Tomography (CBCT) guided lung puncture biopsy. Methods A total of 256 patients with pulmonary lesions who had undergone CBCT guided lung puncture biopsy in Zhongshan Hospital Affiliated to Sun Yat-sen University from April 2015 to August 2016 were enrolled in our study. Among them, 128 cases received lung biopsy used semi-automatic biopsy needle from April 14, 2015 to December 10, 2015 (defined as group A), and 128 cases received coaxial needle lung biopsy from December 16, 2015 to August 2, 2016 (defined as group B). The sensitivity, specificity, accuracy and complication rate of the two groups for malignant lesions were compared. Results The diagnostic sensitivity of group A was 87.3% (96/110) and 96.3% (105/109) in group B, with statistically significant difference (P=0.024).The specificity of both group A and group B were 100%, respectively. The diagnostic accuracy of group B was 96.9% (124/128),significantly higher than that of group A (89.1%, 114/128) (P=0.025). The incidence of complications was 14.1% (18/128) in group A, and 21.9% (28/128) in group B, without statistically significant difference (P=0.142). Conclusion CBCT-guided lung coaxial needle biopsy can improve the sensitivity and accuracy of disease diagnosis.