Tissue diagnosis of new lung nodules in patients with a known malignancy

BackgroundNew lung nodules in patients with known malignancy often represent metastatic disease. However, a lack of pathological confirmation can lead to inappropriate treatment.MethodsA retrospective review was performed of patients with malignancy undergoing tissue diagnosis of a lung nodule between January 2006 and January 2008.ResultsNinety-five cancer patients were identified with new lung nodules. Percutaneous biopsy was the first diagnostic procedure in 64 patients, showing metastatic disease in 37 patients and an alternative specific diagnosis in 9 patients. Eighteen biopsies were nondiagnostic. Surgical resection was the first diagnostic procedure in 31 patients. This confirmed cancer in 16 patients and benign disease in 15 patients. Overall, tissue diagnosis changed management in 31% of patients.ConclusionsPathological confirmation of metastatic disease is vital before treatment, especially in regions with endemic pulmonary fungal diseases, because a number of lung nodules will represent benign processes despite a history of cancer.