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Is a Spiculated lung nodule always malignant?
Hello,
58M, Nonsmoker, No history of cancer
I went to a pulmonologist due to coughing, shortness of breath for over 2 years and got diagnosed with allergic asthma.
Ct scan showed 5 lung nodules all on the right lung.
2 are calcified -most likely granuloma,
2 perifissual- which are most likely benign
1 subpleural nodule 5mm
1 spiculated nodule 5mm
The spiculated lung nodule worries me the most
I did research and all data and studies say that spiculated nodules are malignant with a predictive value of up to 90% ..
Doctor wants to just monitor it with follow up Ct scans.
I read that in rare cases infections, Inflammation or sarcoidosis can have Spiculation but Generally such nodules are a sure sign of Malignancy.
Anoyone on here who has experience ?
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Merci beaucoup !!!
I will look at it right away ( and his cabinet is not far from where I also live, dans le 16eme). Please keep me updated.
Apprécié,
Milana
Hello @democrite, every case is different, so we aren't able to say if this biopsy is warranted or not. You didn't mention how large the nodule/mass is believed to be. A biopsy can be performed for more than a yes/no decision on if this is cancer. A biopsy has the potential to determine what type of cells are contained in the nodule or mass, and based on that, the doctors can determine if further treatment is necessary, and the best course of treatment.
The opinion of another pulmonologist will help you to make a decision on the biopsy.
The PET didn't show uptake/light at all? That's good news! You may want to ask the pulmonologist about the potential for infection, and wouldn't an infection light up on the PET too, just at a lower rate? You are questioning the need for the biopsy. Some people would need to know what the nodule is right away, while others would be comfortable waiting and re-scanning. We all get to make decisions about our comfort levels; comfort with waiting, comfort with procedures, etc. Doctors make recommendations, but ultimately, we get to make the final decisions. Wishing you well!
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2 ReactionsHello @milana, I'm sorry to hear that you are facing this issue, it's never an easy thing to go through. Nodules are rightfully concerning, but they are usually not cancerous.
I'm not a clinician, just a lung cancer patient.
For reference, my first PET showed an SUV over 10. We knew it was cancerous, and that was confirmed by a biopsy. A later PET of a different nodule showed a much lower SUV, and it was not cancer, it was a fungus in my lung, also confirmed through biopsy.
Did you see a pulmonologist? Did they discuss doing a biopsy prior to surgery?
I am so sorry that you have this worry. I have had multiple lung nodules one of which was 4 mm in 2017 in a CT scan. Another scan in 2019 showed it was the same. An incidental ct scan in March of this year showed that it was now 1.2cm semisolid spiculated very suspicious for cancer. Dr. Did not want to do biopsy because of my age and comorbidities. He did a pet scan and could not rule out cancer. He opted for SBRT every other day for five days. It was not difficult at all. I am now waiting or the three month post scan to see how it went. It is the waiting which is difficult. I wish you the best.
After the SBrT radiation treatments, how did they affect you? Did you feel more tired than usual, any change in appetite or bowel habits?
I’m asking because I am facing the radiation treatments very soon. I’d like to have an idea what to expect. I’m 79 & my lungs are not healthy enough to do a biopsy. My module was 1.8 cm. When detected three weeks ago.
In dealing with medical recommendations:
1) Always check the background of your doctors. Specialists have subspecialties. You want a Specialist who treats your problem, not one who usually treats other issues (like asthma instead of lung cancer).
2) The Notes and tests of the doctor will be online and one should read them. It helps understand and provides base for questions. Also sometimes there are mistakes which one can ask to be corrected
3) Look for clinics with expertise, who do research and are able to provide full range of treatments
4) Get second opinion if any doubt
Good luck
Hello @rickjudy2012, I'm sorry to hear that you are facing radiation. These links may be helpful regarding SBRT (Stereotactic body radiotherapy):
https://connect.mayoclinic.org/discussion/sbrt/
https://www.mayoclinic.org/tests-procedures/sbrt/pyc-20446794
Was your nodule identified through a screening exam? Have other tests been ordered, possibly a biopsy or PET scan?
I am glad you have a plan. I had five treatments 20 minutes each. But a friend of mine had ten treatments ten minutes each. I had no stomach issues..just some fatigue which would just hit me so I took a nap. I arrived about 15 minutes early and they took me right on time. I was in and out in 30 minutes. At the first appointment they do marking… you lie on something that moulds to your body and they mark your body with a marker pen and cover it with special tape so that they can put you in the correct same position each time. Then the following visit is your first treatment visit. it is absolutely painless and I had to remain very still. I was able to choose music to listen to which made the time go quickly. You can drive yourself or have someone else drive you but if you bring someone they cannot be in the room with you. The radiologist doctor met me a couple of times after a treatment. He then has rescheduled me for a PET scan 2 and 1/2 months after I finished treatment to see if the tumor has broken up and how my lungs look. They have had very good success with SBRT and I think this is the “to go” procedure for elderly people who cannot have a biopsy or surgery.. I have had no side effects from the treatments except for some fatigue. They have had time will go by quickly once you start treatment. I will be thinking of you.
Thank you so much for your encouraging comments. They help to put me at ease as I face the unknown.
Thank you from r sharing the article about SBRT. It was very interesting & comprehensive enough to inform me about what to expect.
I had a PET/CT scan on 8-15-25. I was as told that because of my age & severe COPD that a biopsy would be very risky.
I’ll see what is recommended after the test results are analyzed & I hear from the doctors.
Thank you again for the helpful information.
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