Background <p>This study evaluated the association between percutaneous transthoracic needle biopsy (PTNB) and recurrence in early-stage non-small-cell lung cancer (NSCLC).</p> Methods <p>A retrospective study was conducted to analyze patients with cT1b-2aN0M0 NSCLC who underwent lobectomy between 2009 and 2021. The exclusion criteria ruled out multiple primary lung cancers and bronchoscopic biopsy. Patients were classified into a PTNB group and a non-biopsy group according to whether they underwent preoperative PTNB. Propensity score-matching was applied, and cumulative incidence of recurrence (CIR) was compared. Fine and Gray competing-risk regression was used to evaluate the association between PTNB and recurrence. Subgroup analyses were conducted according to pathologic stage and the presence of high-risk pathologic features.</p> Results <p>Of 2208 eligible patients, 674 (30.5 %) underwent PTNB, and 1534 (69.5 %) did not. After propensity score-matching, each group included 416 patients with balanced baseline characteristics. In the matched cohort, the 5-year CIR was significantly higher in the PTNB group (21.1 %; 95 % confidence interval [CI], 18.0–26.1 %) than in the non-biopsy group (13.7 %; 95 % CI, 10.2–17.3 %; P &lt; 0.001). In multivariate competing-risk regression analysis, PTNB was independently associated with increased recurrence risk in models incorporating clinical variables alone (subdistribution hazard ratio [SHR], 1.892; 95 % CI, 1.407–2.545; P &lt; 0.001) as well as in models incorporating both clinical and pathologic variables (SHR, 1.851; 95 % CI, 1.375–2.493; P &lt; 0.001). Subgroup analyses demonstrated that the association between PTNB and recurrence persisted regardless of pathologic tumor-node-metastasis (pTNM) stage and the presence of high-risk pathologic features.</p> Conclusion <p>Preoperative PTNB was associated with an increased risk of recurrence for patients with early-stage NSCLC.</p>