Is a Spiculated lung nodule always malignant?

so scar tissue can be spiculated also ? I am new to all of this. It has been less than 5 days. I have a PET scan tomorrow. The doctor saw the 1.4 cm or 14mm spiculated nodule and was 100% sure it was cancer. My first instinct was how quick can you get it out of me. I went to discuss doing a biopsy not removing cancer. I was shocked to say the least. I requested the PET scan. I am really hoping that it is Interstitial Lung Disease which I have plenty of reason to believe it is based on what 2 pulmonologists told me. They did not see my latest CT and radiologist report yet. I am trying to look for signs, like the first post is spiculated always malignant. I am very scared. Some of the information I find helps to reassure me. Some of it scares me. This is the first I had seen about spiculated scar tissue nodules. I see plenty about scar tissue. And mention of large lymph nodes and 2 nodules. I just want to get the PET scan so I am not worrying. And of course I want PET results ASAP - although I dread them at the same time. I am not generally a worrier, in most situations. But I am very worried. Thanks in advance for any information you can provide me.

My gosh, 10-14 days is a long time to sit on pins and needles and wait. Of course you want to just try to push it to the back of your mind and just live your life, but I am sure its always on your mine a little bit. Have you gotten any results yet ?

I see your comment about a non cancerous lung nodule that was fungal. I am not sure what is in my lungs. I know there are nodules, scarring, and large lymph nodes of concern. I went to the surgeon my oncologist sent me to, so he could do a biopsy and see for sure what has been causing me problems. By looking at my CT scan and the report he felt very positive it was cancer and should come out. It is 1.3 X 1.4 cm which is 13-14 mm and doesn't sound like a huge mass. There was another nodule he was not sure about. I thought the PET and biopsy was done before any discussion of removing cancer and margins. But I realize when I said "how soon can you remove it ?" he thought OK she is ready to have it gone schedule some surgery for this woman.

The nurse told me that sometimes if it is small and they go in to do a biopsy it is just as easy to take it out at that time. Which kind of makes sense. I am surprised he didn't tell me to hold my horses that we need to do a PET scan first. I have nodules on my thyroid also. They were going to do a needle biopsy on it at the end of the month. I am hoping if it comes up on the PET that I will have a little more of an idea if it is something to be concerned about. My thinking was also lets do the PET scan so I know exactly what I am looking at. One radiologist commented on "multiple additional smaller sub-centimeter pulmonary nodules concerning for pulmonary metastases in both lower lobes". So I want to know going in if they are mets or not. I have been told I have scarring in my lungs and I am hoping that is what is at the bottom of my lungs. I am wondering if many people have to request a PET scan or if the doctor recommends one along with a biopsy to make a plan before he starts cutting on me.

Thank you for asking. Yes I did get results of the biopsy and it was good news. In spite of the spiculation, size, and every other factor that indicated malignancy.
I am waiting for a valve replacement (which is how they found the nodule) but it was the lung issue that scared me the most.
Hopefully the valve replacement will be a piece of cake (fingers crossed)
Thanks again for checking.

Welcome to Mayo Connect @kiducator. This is a scary time for you, your feelings and questions are all valid, and most of us have been in your shoes. It sounds like you have some experience with lung complications and doctors, listen to your instincts, they will guide you well. Many people have the first instinct of 'get it out', but unless you are in an emergency room, there is time to make some thoughtful decisions. All decisions come with risks, and those need to be carefully weighed.
Our lungs can react to foreign substances in many ways. We can rarely say 'always' when talking about our health or lungs, so I would say that spiculated nodules are not always malignant. The spiculation can be a sign that may lean toward cancer, but always isn't a word that I would use.
Radiologists are accessing what they see on the scan, and yours are recommending further investigation. Without a pathology report from a biopsy or surgical sample, no one can be 100% sure what the nodules are. The PET scan is a great next step.
Once you have the PET results are you able to consult with your Pulmonologist, to see what they may recommend?

What was the size of your initial nodule that was spiculated? I’m happy for you that they were aggressive in treating you.

My first Mayo CT scan right before surgery read: The largest nodule is mostly solid, irregular and somewhat spiculated in the right upper lobe. This is difficult to measure given the morphology but the apical component is approximately 22 mm in diameter with approximately 11 mm of solid density. Another nearly fully solid component more inferiorly/anteriorly is 13 x 17 mm. A inferior lateral component is approximately 10 mm with 8 mm of solid component and more groundglass density inferiorly. they removed a mass measuring 3.1cm and said it was a Stage 1b adenocarcinoma.
I always do my scans at Mayo now for consistency. I have multifocal lung cancer so always watching a nodule

Thank you for your reply. Which mayo do you go to? I spent a few days in Rochester for another issue but it isn’t convenient to fly back and forth. Also very expensive. Jacksonville is within driving distance/. My CT report from 2 months ago, didn’t mention whether my nodules were solid or the density of either module. ? Wish you the best, knowing you are going with Mayo as your care, has to bring some level of peace.

Thanks for the good wishes. Same to you. I live in Minnesota so I go to Rochester - less than two hour drive.
I have wondered if maybe I could have done one of my surgeries in Jacksonville during the winter. Wonder if they get questions like that ???? Oh well, st Mary's is best hospital in the country...I lived in Florida for 10 years, fortunately I came back to Minnesota so when I developed lung cancer I had Rochester nearby.

How are you doing now with your cancer? I have never seen anything quite like Mayo in Rochester! Have a scan, get a report within minutes and already have a new test ordered in relation to the scan report. Genius how proficient it is ran. I was a patient for 4 days, as an outpatient, internal medicine. I’ve never seen so many happy employees in one hospital .