Is a Spiculated lung nodule always malignant?

Thank you so much for your reply..I also am a nonsmoker and my Pet Scan came back negative but advised that does not necessarily mean not cancer and all factors must be weighed..Did you have a pet scan prior to having this noducle removed and did it come back than positive...I am just nervous to have a middle lobe removed on the "maybe" its cancer as thoracic surgeon says 30 to 50% on previous CT as my breathing is only at 55/60% due to damage from being diagnosed with COPD when in fact it is now confirmed (4 years ago) it is Eosinophilic Asthma and treated with a biologic. Thank you

Hi @marchettia, I’m glad your cancer was found at an early stage. Keeping a close eye on it was obviously the right thing to do. You mentioned that you are a non-smoker, did they determine what was driving your cancer, a mutation (ALK, EGFR, etc.) Do you continue to have scans or were you given the ‘ all clear’?

@363, these decisions can be so difficult. Information is your best friend. I know that not all tests are conclusive, but having a clear PET scan is great news. I have lung cancer, but I also have a recent nodule that has been biopsied and is caused by a fungus. My lymph nodes are lighting up on a PET scan, but the nodule isn’t cancer.
Is your doctor recommending continued monitoring or surgery? What type of doctor are you seeing, a pulmonologist or surgeon?

Thank you so much for your reply..I am so sorry to hear you have Lung Cancer, and the lymph nodes lighting up on a PET scan..
I am extremely fortunate as I am seeing both a Pulmonogist who has been been monitoring this nodule for 4 years and when it became 9mm and mostly solid when it started out as ground glass at 3mm she referred me to a Surgeon..
He advised 30 to 50% chance of Cancer and we both decided to monitor for an additional 6 months although he would remove it at that time if I wanted it out. My CT scan is on Tuesday Feb 6 and we will see what that shows. Hoping your health issues are all addressed quickly and great results.

@363, it sounds like you are in good hands with plenty of experts! That's great to hear. How did your PET scan go?

Thank you Lisa..Yes I do feel very fortunate that I am inded good hands..My PET scan which I had a little while ago came back Negative and on Feb 6 I had a follow up CT as it was 7 months since my last one but will not have results till Feb 12 as it is always 4 days after the radiologist see it before it appears in my Health Portal so fingers crossed..Thank you so much for your kind reply

I have been going through the same thing since Aug 23. Found 2 nodules. Been having CTs every few months. There is now a third. Ground glass. The dominant nodule is in the right lower lobe. They have tested my blood work for every single infection, inflammation, and auto immune disease out there. All negative. Had a PET scan and it lit up in the lung. SUV uptakes were 8.3 on the dominant and 4.6 on the other one. The third one was not there when I had the PET scan done in October. They kept saying lets watch it, lets watch it. On my last visit to pulmonary, that was the first time I had ever been told that the dominant one was "spiculated". The second one is pleural based (?). Got me concerned. Now the doctor says, "its time to get aggressive". I have an appt with a thoracic surgeon on the 28th of this month.
Good luck to everyone!!!

I was also not informed about the fact that one of my nodules is spiculated. It was only when I requested my report papers that I discovered one of them was described as such. Everything I've read so far indicates that spiculated nodules are considered a sure sign, so I'm confused as to why some still want to adopt a watch-and-wait approach. It seems they always want the nodule to be at least 1cm to be proactive, but this approach carries the risk of tumor spread. I don't understand why they take that risk. In my case, it's a solid nodule, which is known to be much more prone to spreading even at such small sizes compared to groundglass or semisolid nodules.

Hi @shellyrenee, Welcome to Connect. Sorry to hear that your nodules have changed that much in the past six months, but it's good that they found them at this early stage. I agree, if you've seen that much change over a six month time period, it's certainly time to take action. You may want to ask your surgeon if your samples will be sent for genetic/biomarker testing. As the results can impact any future treatment plans. None of your lymph nodes were lighting up on the PET scan, correct? Are all of the nodules isolated to the same lobe of the lung?

I am confused as well. I was under the impression that the earlier its found, the better your chances of beating it. My CT from Sept: IMPRESSION:
1. Dominant nodule within the medial aspect of the superior segment of the right lower lobe measures 2.8 x 1.8 x 2.2 cm. Subpleural nodule within the lateral right lower lobe measures 16 x 8 x 13 mm. Neoplasm cannot be excluded.
PET SCAN: 1. Right lower lobe pulmonary nodule with a small cavitation shows a focal moderate/intense uptake of 8.2 SUV. Also pleural-based density in the right lateral lower lobe demonstrate moderate focal uptake of 4.8 SUV. Findings are concerning for malignant/metastatic disease.

With that... they still said "lets do another CT in a few months." When I saw my pulmonologist in January, he brought in his boss and she is the one who said the dominant one is spiculated. I havent seen that word in my results. The size of the nodules and the SUV uptake numbers have had me concerned. As well as the fact that everything under the sun has been ruled out. I have a rib that is in almost constant pain (from front to back), I cough all the time, very short of breathe, Ive lost 40 pounds and Im extremely tired all the time. Matter of fact, Im on 2 liters of O2 due to my levels dropping down to 82 during a 6 min walk test, twice now. Its crazy!!! There is something in MY lung that shouldnt be there and no matter how hard he has tried, it simply cannot be blamed on inflammation or infection. I dont understand with all those symptoms, why a doctor would WANT to wait.