Background: Lung cancer is the leading cause of cancer-related mortality worldwide and the tenth leading cause of death in Tanzania. Minimally invasive lung biopsy procedures using CT or bronchoscopy are now available in Tanzania. There is paucity of data on imaging outcomes of individuals referred for imaging with suspected lung malignancy. The aim of this study was to retrospectively review individuals referred for imaging with suspected lung malignancy from 1 January 2019 to 31 December 2024. Materials and Methods: This was a retrospective cross-sectional study on adult individuals that were referred for imaging with suspected lung malignancy. Data was retrieved from the Multi-national Lung Cancer Control Program in the Lake Zone research database. Frequencies or proportions were used for categorical variables. Pearson’s chi square test and logistic regression analysis was used to determine association factors of malignancy. Results: Around 512 individuals were enrolled with median age (IQR) of 56 (43 – 67) years. About 55.6% (273 out 495) presented with a mass on imaging. Of which, 87.2% (238 out 273) underwent biopsy based on visualization of a mass on imaging. Majority of the biopsied masses were malignant (62.6%) while the rest were benign (28.2%) and indeterminate (9.2%) lesions. On regression analysis, a mass on imaging had the highest likelihood on being malignant (aOR (95% CI) =14.0 (8.5 – 23.1). Conversely, features of tuberculosis on imaging had the least likelihood on being malignant (aOR (95% CI) = 0.59 (0.01 – 0.27). Conclusion: Visualization of a mass on imaging was highly predictive of malignancy, especially in the absence of features of tuberculosis. Indeterminate lesions posed diagnostic challenges due to lack of advanced imaging and molecular testing in our settings.