Recurrence Risk Following Percutaneous Transthoracic Needle Biopsy in Patients Undergoing Sublobar Resection for Stage I Lung Cancer

Background Whether preoperative percutaneous transthoracic needle biopsy (PTNB) increases the risk of local-regional recurrence in the context of sublobar resection remains unclear. Purpose To investigate the associations of PTNB with recurrence and overall survival (OS) after sublobar resection in patients with stage I non-small cell lung cancer. Materials and Methods Patients who underwent sublobar resection for confirmed pathologic stage I non-small cell lung cancer (tumor size ≤3 cm) between January 2010 and December 2021 were included in this retrospective study. Propensity score matching (PSM) using 12 clinical and patient confounding factors was performed to balance patients who underwent PTNB with those who did not at a 1:1 ratio. The outcomes evaluated were freedom from overall recurrence, specific recurrence patterns (local-regional, distant, remnant lung, and ipsilateral pleural recurrence), and OS. Cox proportional hazards regression was used to determine the effect of PTNB on these outcomes. Results Among the 2026 patients included (mean age, 62.9 years ± 9.6 [SD]; 989 male patients [48.8%]), 783 (38.6%) underwent PTNB. At follow-up, 192 patients (9.5%) had recurrence: 83 patients had local-regional recurrence, 81 had distant recurrence, and 28 showed both types of recurrence. In the PSM group (n = 1144), PTNB was associated with a greater risk of overall recurrence (hazard ratio [HR], 1.49; 95% CI: 1.03, 2.17; P = .03) and local-regional recurrence (HR, 2.32; 95% CI: 1.25, 4.31; P = .008), without evidence for distant recurrence (P = .29). Among local-regional recurrences, PTNB was linked to an increased risk of remnant lung recurrence (HR, 2.07; 95% CI: 1.08, 3.97; P = .03) but not to ipsilateral pleural recurrence (HR, 1.13; 95% CI: 0.47, 2.73; P = .79). There was no evidence of an association between PTNB and OS (HR, 1.27; 95% CI: 0.89, 1.83; P = .19). Conclusion Preoperative PTNB was associated with an increased risk of local-regional recurrence, particularly in the remnant lung, in patients with stage I non-small cell lung cancer who underwent sublobar resection. Supplemental material is available for this article. © RSNA, 2025 See also the editorial by Sohn and Dao in this issue.