Balancing diagnostic approach and oncologic risk in surgically resected lung cancer: propensity-matched analysis of intraoperative versus percutaneous biopsy by tumor location and morphology.

Background: Lung cancer remains the leading cause of cancer-related death, and earlier detection has increased the demand for accurate histological diagnosis While percutaneous transthoracic needle biopsy (PCNB) and surgical biopsy are widely used, concerns remain about PCNB-related tumor dissemination and recurrence. These risks are influenced by tumor location and morphology, which affect procedural feasibility and oncologic outcomes. This study investigated the association between biopsy method and recurrence-free survival (RFS) in surgically resected lung cancer and evaluated how tumor characteristics may identify subgroups at higher risk. Materials and Methods: Medical records of 363 patients with surgically resected primary lung cancer who underwent preoperative PCNB ( Results: In the propensity-matched cohort (103 patients per group), multivariate analysis showed male (HR 2.11), current smoking (HR 2.12), central tumors (HR 5.47), and higher CTR (HR 16.6) as independent predictors of reduced RFS, whereas PCNB itself was not ( Conclusion: PCNB was not an independent risk factor for recurrence. However, its association with higher rates of locoregional and pleural recurrence along with a trend toward decreased RFS in tumors with adverse CT features suggests careful clinical consideration when choosing biopsy method.