For small lung cancer of the peripheral lung type that is not diagnosed (stage IA), is it better to confirm the diagnosis by preoperative biopsy or by direct surgical local excision for a better prognosis? The answer is provided in a recent article by Japanese scholars. In a retrospective study by Funakoshi Y et al. from Osaka, Japan (1998-2004), 148 patients with stage IA lung cancer were diagnosed by bronchoscopy, and another 86 patients were diagnosed by surgical resection, 19 of whom had positive margins. All patients underwent radical pneumonectomy after diagnosis. The prognostic follow-up revealed that patients diagnosed surgically had better survival and lower local recurrence rates than those diagnosed by preoperative bronchoscopy, and that the presence or absence of positive margins had no significant impact on prognosis. Therefore, for stage IA lung cancer, surgical resection is a more reasonable option.