Is a Spiculated lung nodule always malignant?

A CT scan turned up a 13.5 mm spiculated pulmonary nodule with lucency. It was not there at all 1 year ago. I am 68 years old and quit smoking 40 years ago. Had malignant melanoma removed 38 years ago. Biopsy was performed 2 days ago. Just waiting for results.
Everything I have read leads me to expect bad news. Do I have any reason to expect good news?

Hello @ditot07, Welcome to Mayo Connect. Over the last four years of living with stage IV lung cancer, experiencing a non-cancerous lung nodule (fungal), and reading posts from many people on Mayo Connect, the one thing that I've learned is that there is no way to determine if a nodule is cancerous, other than a conclusive biopsy result. There have been cases here that I was sure would be cancerous but were not, and some that I didn't think would be cancer were in fact that bad news that none of us want to hear.
I hope your biopsy results don't take too long to come back. Did the doctors give you an idea on when to expect to hear from them?

the results of the test is "Indefinite" no significant antibodies found. A very good result. Ill still get scans to watch for growth or shrinkage.

Welcome to Mayo Connect @overthehillsb, I'm sorry to hear that you are facing this finding, and congrats of quitting smoking! IF it is cancer, it is still early, screening is working!, and it sounds like you have the appropriate appointment scheduled soon with a pulmonologist. That's good! Try to take a pause, and not get ahead of yourself. We don't know that it's cancer. There are many people with non-cancerous lung nodules. I have stage IV lung cancer, but also have a 1 cm lung nodule from a fungus. It happens.
While our first instinct is to run to surgery to get it out, that's not always the best approach. Surgery comes with pain, sometimes lifelong nerve pain. I hear of many doctors that want to wait until the nodule is 1 cm before doing a biopsy. That's not unusual. If they insist that you wait, they'll likely do another scan in 3 months.
Biopsies are highly dependent on the location of the nodule, and the overall health of the patient. Over the past four years, I've had a handful of bronchoscopies (down the throat), that I tolerated with minimal side effects.
They may also want to do a PET scan. The nodule may light up more on the PET scan if it is cancer versus some other inflammation or infection. That's not always true of very small nodules either.
You haven't been sick recently, no covid or other lung infections?

I had a home phlebotomist sent to perform Nodify Lung testing. My test result was consistent with an indeterminate result. My nodule is a subsolid . Biopsy is not recommended at this time. I have another CT in December. I was told not to worry at this time. But I still have my concerns.
Don't nodules grow fast if it happens to be cancer? What does subsolid really mean. I was told there are 3 different types solid, subsolid, and ground glass. What is the difference and what does that all mean. My nodule is A spiculated right upper lobe pulmonary nodule measures 5.4 x 6.6 mm, with average diameter of 6.0 mm .

@overthehill, Not all cancerous nodules are fast growing. There are many different types of lung cancer; some are slow growing, and some can be more aggressive. The makeup of the nodule (solid, subsolid, and ground glass) points to how it appears on the scan, but it doesn't tell us if its cancer. All of those types can be benign or cancerous. Sorry, I know that's not very helpful, but it's the way our bodies work. The spiculation can lean toward cancer, but that could just be the way this one scan looks and what one radiologist sees.
It's not unusual for doctors to rescan in a few months. Biopsy comes with risk, and they don't want to put patients through that unless they have to.
One thing that I've found is that our lungs can take a long time to clear out inflammation, infections, or other non-cancerous tissue. We'll be long past our illnesses, but those pesky nodules still show up in our lungs. I'm not diminishing your concerns, just trying to reassure you that waiting is not unusual.
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/understanding-lung-nodules

Thank you so much for the reply. They said to expect results in 10-14 days. So hopefully by July 19 at the latest. Longest 14 days of my life.

Hi @ditot07 , I'm just checking on you. You should have biopsy results back by now. How are you doing? Do you have any next steps in place?

You are so kind to ask. The news I got was fantastic. Even with everything indicating malignancy, the biopsy was good.

I have an aortic valve replacement coming up (which is how they found the nodule) but it was the lung nodule that scared me the most.
Valve replacement should be a piece of cake (fingers crossed).
Thanks again for thinking of me.