Is a Spiculated lung nodule always malignant?

I have had two small 6mm nodules on my right lung that have been watched for the past five years with no changes in size/shape. I had my most recent scan in October of 2023 and this time it revealed a third nodule that was at 1.3cm. and its spiculated. I had a biopsy done later that month and the results were in conclusive. It was decided that I should wait two month and have another scan performed. The last scan had shown an increase in size to now measure 1.9cm. I have met with a thoracic surgeon and I'm now due for surgery on 3/25/2024. I was informed that they would remove a large portion of my lower right lobe and then submit the nodule for a biopsy.
I'm 63 years old and was a lifelong smoker (quit in 2022) and worked in the autobody industry for many years breathing in dangerous chemicals and silica dust.
The surgery being performed will use RATS technology.
I'm very scared and the unknown has mentally and emotionally pushed me to my limits. I do understand that there are others here who might have had the same experience as I'm looking for some insight and hope on how to deal with what I'm facing.
I have never reached out like this to speak with others in similar circumstances.

Regards
David

David, @david1960, It certainly sounds like it's time to take action. The waiting, or active surveillance, can be difficult for some people, but sometimes taking the time to see what these pesky nodules do is worth it. Sorry that yours have grown, but according to your post you should be in surgery today. It's perfectly normal to be scared and stressed to your limits. This is a very scary time in your life, the unknown is not easy, especially when your life is at stake. I struggle the most when thinking about my family and the impact on each of them.
Know that your Connect friends are here to listen, and while we've each had our own experiences, you'll find others here that have had similar surgeries. I'm hoping that you receive good news today, and that your recovery goes well. Join us with an update when you feel up to it. How are you feeling? Are you comfortable sharing the biopsy results?

my lung nodule has been described as, questionable, slightly spiculated.
what does that indicate??? anybody???

Hello @linpvc, The edges of the nodule are slightly spiculated, or slightly jagged, not smooth or rounded. Keep in mind, that these scans are read by human radiologists, and they can have different opinions. In seeing radiology reports over the past 4 years, some will choose to mention certain things, while others are more brief. "Slightly" should be taken into account, the radiologists didn't say that this is fully spiculated. That's good.
From taking a look at some of your other posts it looks like this nodule has grown in the past 6 months. That growth along with the slight spiculation adds to the risk and concern. The only way to know what it is for sure, is to get a sample of it for the pathologists. It sounds like you are on the right track for that procedure. That's great! It's never easy to wait for appointments though. How are you handling the down time between appointments? Have you come up with methods to keep your mind off of this?

im trying to keep busy until I see pulmonologist in 11 days. i messaged him asking for a biopsy. the next scan would be my sixth. i'm freaked out a bit since seeing that horrible word, spiculated . no matter it was described as questionable. Wondering why it was even mentioned if not sure, or maybe I should know that there is a "possibility" margins are spicukated even if only slightly. My head is going in circles. but Im pretty sure i need a biopsy, if doctor concurs. Your message back to me was so welcome, thank you for taking the time. you and I seem to agree on necessary concern this warrants
im staying calm as i can trying to stay busy. i am a singer, i want to keep that ability, it brings me much pleasure. but i value my life more than my voice.
avain, thank you sooooo much❤️

you mentioned that it is in a place that majes biopsy impossible. where is it located?

Hello @linpvc, some nodules are difficult to biopsy when they are deep in a lower lobe or it may be too dangerous to biopsy depending on the proximity to the heart or certain arteries. Pulmonologists are getting better at reaching difficult nodules through the use of robotic bronchoscopy, allowing greater access to the entire lung. (https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/robotic-assisted-bronchoscopy-faq)
I hope your appointment goes well next week. Did they respond to your message requesting a biopsy?

Thank you for your response. This is hard for and I’m sure others to go alone. . It is located in lower area of lung in RML on the surface of the pericardium. How are these treated if can’t biopsy? Plus questionable slight speculation. It is 17mm. X 9 mm c 14 mm.has not grown in 2-1/2 months.
Dr answered my message, saying we’ll discuss next meeting, may 7, tomorrow.

It is located on lower part of right lung on pericardium surface in lower part of lung base of RML

it is located on RML on lung base on Pericardium surface
just returned from doctor. it is spiculated, slightly, he says no thoracic surgeon would biopsy it because of its location. so instead of biopsy, he will watch its size. ill have a cat scan in six months. if it grows he'll take as a sign of malignancy and ill need to have the nodule removed by open-heart surgery or hopefully VAT.
i told him of a blood test, Nodify XL2 and Nodify CDT
MY healthcare provider doesnt have it but it is out there and the doctor Googled it. he is researching it for me. i want it as it detects lung cancer even if in-situ. i've requested it.
have you heard of it