Is a Spiculated lung nodule always malignant?

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 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.

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.

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.

@shellyrenee, With the symptoms that you are having, and the CT and PET results, you certainly sound like you need treatment. The weight loss and the rib pain are certainly concerning as well.
Are you being seen at a medical institution that sees many cases like yours, or is it a smaller local clinic/hospital? Most experts will urge patients to be seen at a teaching hospital, or one specializing in cancer, or even specializing in thoracic oncology.
Waiting can be so hard on us, the emotions of not knowing the next steps can be overwhelming. Is it possible for you to get on a wait list for an earlier appointment with the surgeon?

Wow. That really doesn't seem right. With a size of 2.8x1.8x2.2 cm, they should have acted right away and performed a biopsy, especially if the lung nodule had spiculated characteristics. In addition to the increased SUV uptake and your symptoms, they should not have waited at all. It’s always about early detection, but when they find suspicious findings, they still expect us to just wait and do nothing. I bet if they themselves were affected with such findings, they wouldn't be so careless and would be much more proactive.

@darwin66 , I'm not sure that I would be comfortable with a long wait-and-see period. Each patient's tolerance for risk is different. I tend to be more analytical and want data and facts. Have you been able to have a PET scan to see how much uptake there might be to the nodule? Are you able to access second opinion?

I will get a second opinion soon and ask about removal options. Unfortunately, many doctors don't take our concerns seriously and are not willing to take our wishes to account . The PET scan was already declined by my previous doctor, as it apparently won't show meaningful results for nodules under 1cm. However, I believe it would still be beneficial to have the scan to potentially rule out metastatic disease or other suspicious findings.
It's very frustrating and hope for better care with the new doctor.

I will get a second opinion soon and ask about removal options. Unfortunately, many doctors don't take our concerns seriously and are not willing to take our wishes to account . The PET scan was already declined by my previous doctor, as it apparently won't show meaningful results for nodules under 1cm. However, I believe it would still be beneficial to have the scan to potentially rule out metastatic disease or other suspicious findings.
It's very frustrating and hope for better care with the new doctor.

I agree, 100%.
Let me say, they did a fine needle aspiration on one of the nodules. But here is my concern with that, even though it came back negative for malignancy. I dont trust it. The chances of false negative are higher than we know, with FNA. Also, it was sent to ONE pathologist, right there at the hospital that the biopsy was done at and the result was back in 1 day. When my daughter was diagnosed, it was sent to 4 major cancer hospital pathology labs. I could go on and on about "false negatives" and their impact on the patient after a second biopsy was done and came back malignant. And all of these were on people I personally know. So not just something Im reading on a website that happened to someone I dont know. I know every one of these people. Thank GOD, they advocated for themselves, because every single one of them came back as cancers. Breast, rare uterine, prostate, etc. Cancer is very rampant in my family as well. Lung, stomach, colon, bladder, kidney and my daughter had non Hodgkin's lymphoma.
Its just wild.... I finally told my pulmonologist to think of me as his mother, sister, wife and asked him what would he be doing different at this point. I am 49 years old. On oxygen and having these issues. I have grandkids. And yes, the not knowing is reeking havoc on my mental health. Some kind of bad.