OBJECTIVE: This study aimed to evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation (MWA) combined with coaxial needle biopsy performed in different sequences for treating lung nodules with signs of malignancy. METHODS: A retrospective analysis was conducted on 51 patients (56 lesions) with lung nodules treated with MWA and coaxial needle biopsy between January 2020 and March 2024. Patients were divided into Group A (post-MWA biopsy
26 patients, 29 lesions) and Group B (pre-MWA biopsy
25 patients, 27 lesions). Ablation parameters, postoperative complications, prognosis, and pathological diagnosis rates were compared between groups. Patients with malignant pathology findings from both groups (Group C) were analyzed for overall survival (OS) and progression-free survival (PFS). RESULTS: Technical success for needle biopsy and MWA was 100%. Pneumothorax incidence was 24.14% (7/29) in Group A and 33.33% (9/27) in Group B ( CONCLUSIONS: Biopsy post-MWA maintains pathological diagnostic accuracy while significantly reducing the incidence of intrapulmonary hemorrhage compared to pre-MWA biopsy.