title: Tissue diagnosis of new lung nodules in patients with a known malignancy.
abstract: BACKGROUND
  New lung nodules in patients with known malignancy often represent metastatic disease. However, a lack of pathological confirmation can lead to inappropriate treatment.
  
  
  METHODS
  A retrospective review was performed of patients with malignancy undergoing tissue diagnosis of a lung nodule between January 2006 and January 2008.
  
  
  RESULTS
  Ninety-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.
  
  
  CONCLUSIONS
  Pathological 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.
authors.affiliation: Department of Surgery, Section of Cardiothoracic Surgery, University of Arizona, 1501 N Campbell Avenue, Room 4402, Tucson, AZ 85724, USA. smeyerson@surgery.arizona.edu
authors.forename: Shari L
authors.initials: SL
authors.lastname: Meyerson
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wilson
authors.forename: Stephen
authors.initials: S
authors.lastname: Smyth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult