Is a Spiculated lung nodule always malignant?

Welcome to Mayo Connect, where you will be able chat with others in your same situation. It is normal to be scared when faced with uncertainty, but take a deep breath and assure yourself that you are on the way to a diagnosis.
If it was found 2 years ago, and is now becoming spiculated, you are probably correct that it is slow growing.
When is the PET scan scheduled? What has your doctor told you so far?
Sue

Hi,

Thanks for your kind words, really appreciated. I am having a follow up in 10 days and yes, having lot of anxiety during these uncertain times and really hope i will have more relevant information's shortly

I have had a nodule followed for 2-3 years. This spring it had grown a little and looked like adenocarcinoma. Had biopsy that confirmed that diagnosis. Stage 1. Just finished radiation. Supposed to be curable. Another scan in 3 months.

@junerose42
Hi Connie,
I was able to have a biopsy via bronchoscopy.
Pathology came back adenocarcinoma stage 1.
I was offered either surgical resection or radiation- both giving same result.
I chose radiation- assumed recovery from surgery would be worse for me.
I had 3 separate treatments. There were no immediate side effects but experienced fatigue when all done. Still not bad.
I have follow up CT scans every 4 months- so far so good. Eventually the scans will be done every 6 months and so on.
I also see my pulmonologist on a regular basis and they check pulmonary function.
I feel fine now and I don’t really worry. If anything will show up- I’ll deal with it.
I was definitely more anxious after my breast cancer diagnosis 33 years ago. I’m finally not worried about that either.
Good luck and hope all goes well. Let me know what they find!

What size was your nodule?
Due to the small size of my nodule Biopsy and Petscan won’t be meaningful.
So doctor suggested the watch and wait approach.
My doctor said that infection, inflammation is a possibility and if it shows any growth on next scan we’ll do surgery.
But given all the data regarding spiculated lung nodules with the up to 90% it’s hard to believe that I will be one of the rare cases where it turns out to be just infection or inflammation..
However the data and studies also mostly refer to nodules that are > 1cm.
Not much information is available on smaller nodules with Spiculation, So I don’t know if the risk of 90% applies to smaller nodules as well?
According to The Fleischner guidelines for smaller nodules with suspicious borders such like Spiculation a follow up in 3-6 Months is recommended.
I think it’s just a matter of time till my nodule grows and is then confirmed malignant and with any growth the possibility of it spreading increases.
Therefore I’m debating whether I should just insist on getting surgery right away to get rid of it as soon as possible.

Hi everyone,

I had the results of my last CT scan follow up today and here it is :

Laterally in the mid right lung, there is a 1.4 x 1.4 cm pulmonary nodule. It is lobulated and mildly spiculated. It is slightly increasing in size since the original study of 4/23/2024, when it measured 1.2 x 0.7 cm

As you may guess, it's triggering a lot of anxiety and would like to know what you think in terms of possible diagnosis, thanks in advance for your answers.
Best regards

Hello @democrite , what are your news, follow up and course of action ? I too am in a similar situation, one lung nodule was discovered in middle right lobe with 13 mm diameter on July 20, after initial CT scan ( discovered by chance) of 12 mm. Pet scan showed SUVmax of 2.1, and the doctors decided a surgery. Im seeing a surgeon on 27 avgust.

Hi,
News are confusing and challenging choices :
I had a PET scan 3 weeks ago, PET SCAN was negative, not showing any "light" (which is positive). and my surgeon programmed a Bronchoscopy Biopsy (non invasive Biopsy)for August 27th...
I am actually in Paris (i am a French Parisian living in USA for 7 years) and i had an appointment with a very renown (45 years of Practice in USA and France) he was shocked my US Doctor program a Biopsy after a negative PET, told me it's insane and ridiculous since results will be negative as well... He recommends me antibiotic treatment for a month and repeat a CT scan after saying it's most likely an infection who enlarge the nodule. He told me he is absolutely against the programmed Biopsy and to go for a second opinion in Chicago asap (where i live). He was also half joking if i am doing the biopsy (with all risks and possible side effects) who is going to be negative since the PET was as well that i should sue them and make millions since not a reasonable doc would order Biopsy after a negative PET...
So i am totally confused, just made appointment with another pulmonologist for next week since the biopsy is planned in 2 weeks, very very troubling situation..

Hi @democrite ,
What a coincidence, I live in Paris ( here, as I met my french husband in Canada ). From what I read, if PET scan doesn't light up, that is a very good news !! The pneumologist you mentioned with the extensive experience is in Paris ?Would you mind sharing the hospital / clinique if in Paris ?I tried to get a second opinion/ appointment in Gustave Roussy, but they didn't accept me, as malignancy is not yet confirmed. My nodule was discovered by chance, after I which got an app in EHGP with a pneumologist,unfortunately, my PET scan showed moderate metabolic activity, did bronchial fibroscopy, but the nodule could not be reached, so no sample,however infection came négative, after which a surgery is recommended....my only hope is that if malignant ( which they don't want to confirm at this stage, but waiting after surgery) it is isolated, one nodule and for now 13 mm...hope you continue to get good news !!!

Hi @democrite ,
What a coincidence, I live in Paris ( here, as I met my french husband in Canada ). From what I read, if PET scan doesn't light up, that is a very good news !! The pneumologist you mentioned with the extensive experience is in Paris ?Would you mind sharing the hospital / clinique if in Paris ?I tried to get a second opinion/ appointment in Gustave Roussy, but they didn't accept me, as malignancy is not yet confirmed. My nodule was discovered by chance, after I which got an app in EHGP with a pneumologist,unfortunately, my PET scan showed moderate metabolic activity, did bronchial fibroscopy, but the nodule could not be reached, so no sample,however infection came négative, after which a surgery is recommended....my only hope is that if malignant ( which they don't want to confirm at this stage, but waiting after surgery) it is isolated, one nodule and for now 13 mm...hope you continue to get good news !!!