The importance of a solitary circumscribed mass in the lung has attracted increasing recognition in recent years. As a result of the extended use of roentgenologic examination of the chest, detection of these lesions is now commonplace. Advances in thoracic surgery have resulted in an effective means of definitively managing these lesions. As a consequence, complacency is no longer justifiable on the part of an attending physician who discovers such a lesion with its recognized malignant potentiality.Circumscribed mass lesions of the lung are generally peripheral in location with respect to the pulmonary hilus. Because of this, important clinical problems in management and diagnosis arise. In the first place, symptoms develop less commonly and at a later stage than those caused by lesions lying close to a central bronchus. Consequently, it is more difficult to impress on the patient the importance of assuming an active approach toward the management of these frequently asymptomatic lesions. Second, the peripheral location of the lesion renders it inaccessible to direct bronchoscopic visualization and frequently reduces the tendency for the production of sputum containing exfoliated cells or significant organisms. For these reasons, important diag¬ nostic aids available for the study of most diseases of the chest are ineffective for the investigation of solitary cir¬ cumscribed lesions. The problem confronting the clini¬ cian is, therefore, a complex one. On the one hand, the possibility is ever present that the rounded shadow may represent a malignant process in a relatively early and operable stage. On the other hand, recourse to explora¬ tory operation should never supplant simpler, less haz¬ ardous diagnostic measures. What then should be the clinician's policy with regard to these lesions? What diag¬ nostic procedures are indicated? To what extent should preoperative diagnostic studies be pursued? What clin¬ ical features of a circumscribed mass increase the sus¬ picion of malignancy? Finally, under what circumstances should exploratory thoracotomy be advised? Answers to these questions can be obtained only by a comprehensive study of a large and varied group of solitary mass lesions of the lung. In an attempt to formu¬ late a working policy applicable to all patients with such lesions, the material available to us at the Mayo Clinic has been reviewed in detail. All cases of surgically removed solitary circumscribed lesions without regard to size, status of preoperative diagnosis, or presence of respira¬ tory symptoms constitute the basis of this study. It is our feeling that a true evaluation of various diagnostic pro¬ cedures and a sound basis for dependable advice regard¬ ing operation can best be obtained from the study of all circumscribed lesions rather than by a study of a limited group of them restricted as to preoperative diagnosis, size, or symptomatology. MATERIAL AND METHOD OF STUDYThe records of the cases for this study were obtained from the files of the Mayo Clinic after the chest roentgenogram...

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