Rationale: Lung cancer dissemination has been cited as a potential adverse consequence of diagnostic percutaneous transthoracic needle biopsy (PTNB) of lung nodules. Despite multiple reports in the literature of malignant spread along the needle track, the potential effect of lung cancer dissemination following PTNB on survival is unknown. Objective: To evaluate whether diagnostic PTNB is associated with increased risk of lung cancer death. Methods: This study included 8,607 cases of surgically resected Stage I non-small-cell lung cancer diagnosed between 1991 and 1999 from the Surveillance, Epidemiology and End Results registry linked to Medicare records. Overall and lung cancer-specific survival of patients who had and did not have PTNB was compared using Kaplan-Meier curves. Stratified survival analyses and Cox regression were used to compare survival while adjusting for potential confounders. Results: Approximately 36% of patients underwent diagnostic PTNB. Overall and lung cancer-specific survival was not different for patients that underwent PTNB as part of their cancer diagnostic work-up and those who did not (p=0.57 and 0.46, respectively). In stratified and multivariate analysis, PTNB was not associated with an increased risk of death after controlling for age, race, income, access to care, comorbidities, tumor histology and size, and type of treatment received. Conclusions: In this large national sample, preoperative PTNB was not associated with increased risk of death. These data suggest that PTNB can be safely used for the work-up of pulmonary nodules when there is a suspicion of lung cancer.