Approximately 150,000 solitary pulmonary nodules are discovered annually in adults older than age 50 years, with 40% to 50% being malignant. 1 Histologic diagnosis is often impossible by radiographic assessment or bronchoscopy alone. The evolution of minimally invasive techniques like transthoracic biopsy guided by computed tomography (CT) and videoassisted thoracoscopic surgery (VATS) has offered alternatives other than open surgical biopsy for preoperative diagnosis.Although CT-guided biopsy and VATS are effective and valuable thoracic diagnostic procedures, preservation of oncologic principles remains an issue. Despite its rarity, tumor dissemination after transthoracic biopsy or VATS 2 is a potential risk. The significance of tumor seeding along the needle or port tract with respect to management of lung lesions suspected to be malignant, as well as the extent of treatment required and the overall impact on the patient's prognosis, has yet to be defined.Clinical summary. A 51-year-old man had Mycobacterium tuberculous peritonitis. A chest radiograph showed a 1.5 cm lung nodule in the left upper lobe. Medical history was noteworthy for pancreatitis, hypertension, and a 50 pack-year smoking history. Physical examination showed no abnormalities. CT scan of the chest and abdomen confirmed the presence of the mass and showed no mediastinal lymphadenopathy and no hepatic or adrenal masses. Bronchoscopic examination showed no intraluminal masses and washings were inconclusive. A CT scan-guided percutaneous biopsy was performed with a 0.8-mm diameter (20 gauge) screw tip needle (Rotex catheter, Ursus Corporation, Stockholm, Sweden), with two passes being made into the suspicious area. Pathologic study yielded malignant epithelial cells consistent with non-small cell cancer.The patient underwent a left upper lobectomy and mediastinal lymphadenectomy. A pathologic diagnosis of moderately differentiated adenocarcinoma (tumor size 1.2 × 1.1 × 1.0 cm) with normal (negative) lymph nodes was returned and classified as T1 N0 MX lung cancer. The patient did well after the operation and received no adjuvant therapy.

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