What is the key question?

• Does preoperative transthoracic needle lung biopsy increase pleural recurrence in stage I lung cancer?

What is the bottom line?

• Authors conducted a systematic search of OVID-MEDLINE, Embase and the Cochrane Database of Systematic Reviews through October 2018. Eligible studies were original articles on the risk of pleural recurrence in stage I lung cancer after transthoracic biopsy.
• The preoperative transthoracic biopsy was associated with a higher risk for pleural recurrence manifested solely (subdistribution HR (sHR), 2.58; 95% CI 1.15 to 5.78) and concomitantly with other metastases (sHR 1.99; 95% CI 1.14 to 3.48) than other diagnostic procedures when considering death as a competing event for recurrence.

Why read on?

• This study reveals the association between preoperative transthoracic lung biopsy and increased pleural recurrence in stage I lung cancer, highlighting a cautious application of transthoracic biopsy for the diagnosis of early lung cancer for which curative treatment is anticipated.