A smoker or ex-smoker with a new density on chest x-ray has a 60-70 chance that the mass is a lung cancer. For this reason, the safest approach is to remove the mass surgically, if the patient is determined to be a reasonable risk on the basis of physiologic testing.
As mentioned above, neither bronchoscopy or needle biopsy is reliable in ruling out lung cancer.
If a diagnosis of lung cancer has been made by one of the tests mentioned earlier, surgical removal of the cancer is indicated if the tumor is Stage I or II.
Carefully selected cases of Stage IIIA NSCLC should have surgical resection.
Stage IIIB and IV are rarely candidates for surgical resection.