Situation
A patient who previously underwent a right upper lobectomy for a T2N1 adenocarcinoma now presents with a nodule in the left lower lobe. What do you do ?
It depends on whether you think this is a metastasis or a new primary. Needle biopsy may be unhelpful as the new primary could have the same histological type. The longer the previous operation was in the past the more likely this is a new primary, so you would investigate the patient as any other new referral for a potential resection.