Increased Lung Cancer Recurrence Following Transthoracic Needle Biopsy

CT-guided transthoracic needle biopsy (TNB) has allowed for increased detection of small pulmonary nodules in lung cancer patients. However, it also poses a risk of iatrogenic damage. This single-center study aimed to investigate the risk profile of preoperative CT-guided TNB. A total of 1,077 patients with stage 1A non-small cell lung cancer (NSCLC) and no visceral pleural invasion was included; 190 of whom underwent preoperative TNB and 823 were in the non-TNB group. Postoperative CT-TNB surveillance was monitored for locoregional recurrence, and propensity score-matched cohorts were compared. The locoregional five-year recurrence-free survival (RFS) in the non-TNB cohort was 96.8 percent and 88.3 percent in the TNB cohort, with no significant difference observed. In the TNB cohort, 21.6 percent of patients experienced post-TNB pneumothorax. Based on multivariable analysis, the history of TNB was a risk factor for locoregional recurrence and a negative prognostic factor for both locoregional and overall RFS. While not conclusive, the high rate of complications associated with TNB and its effect on RFS should be considered when offering TNB preoperatively to those with early-stage lung cancer.