Questions on CT showing New 4B Spiculated Nodule

Hi, I've attached a copy of the CT Scan I had yesterday. I'm scared and I'm hoping some people can perhaps answer my questions.

What I know:
I have Type 2 diabetes that is well controlled on Metformin
I feel fine other than some hip pain that has been xrayed and told it was normal aging and nothing remarkable.
I am a 68 yr old widow with no living family or other form of support so I don't have transportation because I cannot drive.
I am a smoker 🙁 and I have diabetes that is well controlled. Again, I feel very good.
I am overweight and do not get enough exercise.
There is no history of Cancer in my Family
The last CT I had was almost 15 years ago and was in the ER when I had the Swine Flu. Nothing was mentioned to me then other than they asked "Has anyone ever mentioned that you might have Empysema?"
I cannot drive

Here are the questions I have:

1. How high is the probability that this is malignant and, if so, what tests will tell me what stage? The spiculated part is really concerning.

2. My primary care doctor says this is not her area of expertise and wants to give me a referral. I live on a remote island and will have to travel a far distance including over an hour on the ferry one way to get to a pulmonologist or whoever she refers me to so I want to be sure I get to the right doctor. If something is wrong I would like to go to the doctor that will be with me all the way through not just anyplace that gives a PET/CT. Is this a reasonable request?

3. What comes next AND how quickly? PET/CT? Biopsy? I am in the process of selling my house and moving to an area closer to medical care. When I say "in the process" I mean I have received offers but have not yet found a place to move to yet. Do I have time to wrap this up and be settled in a new place closer to the doctor or should I put everything on hold and try to get Angel Flights to treatment if any is necessary? I really don't know how quick any of this happens!

THANK YOU ALL SO MUCH! I will post more as I get more info. Following is yesterdays CT report:

CT LUNG SCREENING WO CONTRAST
Clinical: PERSONAL HISTORY OF NICOTINE DEPENDENCE
Comparison: June 25, 2021

Procedure: Noncontrast chest CT using low-dose screening technique. CT was performed using one or
more dose reduction techniques: Automated exposure control; adjustment of mA and/or kV according to
patient
size; or iterative reconstruction. Lung lesion Category designation and management based on ACR
Lung-RADS 2022 guidelines.
Unless otherwise stated, any renal cyst, thyroid nodule, or adrenal nodule mentioned in this report
warrants no additional evaluation or follow-up.
Findings:
LUNGS: There is a new irregular pulmonary mass within the left upper lobe inferiorly measuring 1.0
cm.

Stable 6 mm nodule within the inferior right lower lobe.

Mild bandlike scarring versus atelectasis within the inferior right upper lobe.
Emphysema.. Unremarkable airways. PLEURA: Normal
CARDIAC: Normal heart size.
CORONARY ARTERY CALCIFICATIONS: None
MEDIASTINUM: Normal caliber of the aorta and central pulmonary
10/18/25, 3:45 PM My PeaceHealth - Test Details
Study date: Oct 17, 2025 2:48 PM
Collection date: Oct 17, 2025 3:10 PM
Result date: Oct 17, 2025 3:18 PM Result status: Final
arteries. No lymphadenopathy.
BASE OF NECK AND CHEST WALL: No significant abnormality.
UPPER ABDOMEN: No significant findings. SKELETON: Unremarkable for age.
IMPRESSION:
LungRads Score: 4B - Very Suspicious.
Follow-up: Very suspicious follow up Chest CT, PET/CT, Sampling, and/or pulmonary referral
Other significant findings: No.
Emphysema.