Lung cancer is the leading cause of cancer-related morbidity and mortality worldwide and Lung mass is the most common radiologic presentation of lung (1). An extensive literature search to look for standard evidence based description of lung mass and its management protocols highlighted scarcity af literature - lung mass continues to remain an ill-defined entity. Conventionally, a lung mass is defined as ‘any pleural or pulmonary lesion seen on chest radiograph as an opacity greater than 3 cm’(2). Pulmonary nodule is the term used for any rounded or irregular opacity measuring 3 cm or less in diameter surrounded by normal lung parenchyma (3). Differentail diagnosis of a lung mass includes lung neoplasm, tuberculosis, nodular Sarcoidosis, lung abscess, focal organizing pneumonia, inflammatory myofibroblastic tumor and pulmonary liposarcoma. These differentials are frequently discussed in the literature; however, there is paucity of evidence to suggest proportional distribution of these etiologies. Subsequently. a tissue diagnosis is required to confirm the diagnosis and manage the patient accordingly.

Lung cancer is the leading cause of cancer-related mortality worldwide including India. However, mortality rates are higher in india as large number of cases are diagnosed with advanced stage disease, one of the attributable cause of poor treatment outcome.(4) Delay in diagnosis in patients with lung mass is a potential cause of progression of disease and delay in treatment. Delay in diagnosis can occur at various levels, and a number of factors are responsible for it. Primary delay is defined as time duration between the occurrence of symptoms and the first contact with the clinician. In other words, whne a patiet delays seeking medical care in the early stage of disease when symptoms are mild. Common factors that contribute to primary delay are – (a) lack of awareness, (b) poverty, (c)  unavailablilty of health care facilities in the vicinity, and (d) widespread presence of unrqualified medical practitioners. Secondary delay is defined as the period between the patient contact with the clinician and the definitive diagnosis of the disease.(5) Causes of secondary delay usually includes – institution of empirical treatment (usually antituberculsosis treatment) by the clinicians or unqualified practitioners, scarcity of expertise for tissue biopsy, and long waiting time at public hospitals.  

Tuberculosis is endemic to Indian subcontinent and is one of the disease which may masquaerade lung cancer very closely in both clinical and radiological features. In a developing economy like India, every fifth case of lung cancer is initially diagnosed as sputum-negative tuberculosis and treated accordingly (6). Empirical anti-tuberculosis treatment is highly prevalent in India due to high prevalence of  pulmonary tuberculosis and is a major attribute to secondary delay in the diagnosis of lung cancer. Sarcoidosis masquerading as lung malignancy and vice versa is often reported and can, at times, be a diagnostic challenge. These factors delay the diagnosis of lung cancer and results in poor treatment outcomes.

The study is aimed to analyze the possible causes of lung masses in  patients residing in a subhimalayan region and the reasons for delay in definite diagnosis. An attempt will be made to generate score based on clinico-pathological characteristics of lng masses to diagnoses lung cancer. This score can help avoid the delays in the management of lung cancer.