Hi.. Metastasis/primary lung tumour and infective lesions such as granulomas(tubercular).. Hence a histopathological diagnosis is essential to determine the plan of treatment, since the treatment will not be the same for both these conditions.. So the biopsy is necessary.. Other test that include the blood counts, montoux tests are indirect evidences which can be useful, but not any where close to the biopsy.. Discuss with your doctor for more details...