RUL nodule of 4mm, 6 months later it was 9mm and speculated.

9mm will be too small to biopsy and be certain that they actually got a piece of the tumor. When they're that small there's a strong probability of a false negative.

There are other disease process that can cause a nodule to be spiculated. Insist that the follow up be at 2-3 months.

Thank you. I wasnt clear I guess but I wasn’t asking about a biopsy. I know 9mm is too small to biopsy, but I was asking about having a pet scan . Which is what the radiologist recommended two months ago.

Don't be shy about asking the doctor why. They have thousands of patients, you only have yourself. If you are not satisfied with the answer get a second opinion.

Will your insurance company cover it? It's an expensive test and they hire non medical people to make decisions about authorization of a test based on parameters that often don't fit the patient's true need.

Hi @mmga, The PET scan may not provide the conclusive answer that you are looking for at this point. PET scans will show metabolic activity of cancer, but they also show activity of infection or inflammation. I've had both cancer and inflammation show as active on a PET scan. Small cancerous nodules may not always have a high uptake value and may appear similar to infection or inflammation. Knowing that the nodule on the left has resolved, tells us that there is something that your body was fighting.
Radiologists often add notes to their reports indicating recommendations. Sometimes they may do that to cover their own liability and to get the attention of the ordering provider. Remember that radiologists don't treat cancer. Pulmonologists and oncologists are much better at recommending next steps.
I do like that you continue to ask questions of your providers. Wanting answers shows that you are involved in your own care. If you don't get the PET, are you comfortable with waiting a year for another CT, or are you wanting to scan in another 6 months?

Thank you so much for the information. Makes a lot of sense, also. I’m not comfortable waiting 6 months, primarily because the module that hasn’t disappeared, was 4mm, 6 months later it was 9mm and spiculated margins, so I’ll probably request a pet scan in 6 months .

I’ve been where you are and first take a deep breath. I can read your nerves in your writing.
I can tell you I’ve walked in your shoes so many times. I’ve had so many nodules all over both my lungs for years. They seem to dry up but they do leave a scar which is unusable for air exchange. My first one was 9mm at the top of my right lung. I had a scan every 3 months. I had gotten Valley Fever and the spores were attacking! My doctor referred me to the Mayo and after numerous tests they decide a portion of my right lung needed to come out. I couldn’t stop coughing. The surgery went well.
Don’t spend a lot of time comparing what the radiologist wrote and what your doctor is telling you. Radiation transcription just happens to be so matter a fact. Realize all though they may be good at reading Xray they don’t know you and most likely never seen you. You doctor on the other hand …..different story. Listen to your doctor if you have faith in him/her. Good Luck.

I totally agree about getting authorization from insurance companies to cover diagnostic testing, or treatment. Thank you so much for your advice. It actually makes sense now when I step back and read others opinions. 👍

You have given me more information in your reply than my pulmonologist has given me in the last two appointments. Thank you! I wasn’t expecting anything to show up on my CT scan, I am the one who requested the low dose screening every year, and they were all negative, minus some scaring from pneumonia, and very mild COPD. I was also the one who requested a regular CT because I have felt so bad for so Long, I felt like the COPD must be a lot worse, which it wasn’t, 🙏. My pulmonologist was fine with doing another one 6 months after my last one. (Previous one showed scaring as well but a 4mm nodule. ) When the pulmonologist’s report from the CT scan said there were nodules on both lungs, the 4mm was now 9mm in 6 months. He said “first choice would be, do a pet scan and or biopsy but they are too small to biopsy and Pet scan wouldn’t show much at this stage.” Radiology report I was finally able to read, after many phone calls to pulmonologist office, took me a month to get a copy! That report showed larger nodules (but still small) and margins were spiculated on the right. Final impression “recommend pet scan” . I understand now from others on here and from you , PET scan wouldn’t be helpful at this point.
While pulmonologist has yet to address speculated nodule . So you can see why I felt like it was up to me to take some control. Healthcare isn’t what it use to be.

Thank you again for explaining in detail how infections inflammation can also appear to be cancer and vice versa. I need to be more patient. 🫣.

I have to disagree! Better safe than sorry. I had a LUL lesion and without hesitation my pulmonologist ordered a PET scan. There's always that chance..... get's that differential diagnosis out of the way and you can continue with CT scans for follow-up. Seen too many "shoulda, woulda, could's in my time!