Is a Spiculated lung nodule always malignant?

I applaud your research efforts. I think the "up to 90%" comment tells the story. I had nodule (RUL) removed sixteen months ago. It was spiculated, and it was malignant (stage 1b). The wording on the CT scan can be informative. My first CT scan noted it was spiculated and said it could be cancer, scarring or something else. (I had quit smoking 20 years before). The CT scan suggested a PET scan and the PET scan "lite up" in two areas. I had biggest nodule removed 16 months ago and now about to remove the other.
I have multifocal lung cancer so have other nodules that are considered cancer and they wait until they get to a certain size before treating. They want to preserve lung tissue. They monitor nodules with CT scans but also check them with PET scan which tells a lot.
If you have any doubts, seek a second opinion. I did. Look for Pulmonologist with specific focus in lung cancer.

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.

They removed a 3.1cm mass from my upper right lung (stage 1b not 1a because of size). However, the measurements on CT scans refer to ground glass, semi solid and solid parts so it is difficult to compare to your 5mm. Did they say it was solid or semisolid?
I have three and six month follow-up scans and they know my other nodules are adenocarcinomas (all thought to be primary cancers). But the objective is to preserve lung tissue/capacity for quality of life so one can't just cut them out. My two largest nodules were in good locations for surgery. And I am having Video Assisted Surgery which is a lot easier on a person. My other nodules will probably have radiation ...and they want a certain size for that also.
I relate to your desire to do something. I am the same.
Look for a Pulmonologist who specializes in lung cancer (Pulmonologists specialize in certain areas), and be sure the institution offers the latest treatment options for lung cancer - like Video Assisted Thoracic surgery and more advanced radiation, other targeted therapies. An experienced Specialist will know when and how to treat.

i WAS TOLD MY NODULE NOW LOOKS PICULATED AND A PET SCAN IS NEXT. i AM SO SCARED. i QUIT SMOKING OVER 30 YRS AGO. THE NODULE WAS FIRST FOUND 2 YEARS AGO SO ISN'T GROWING FAST, I THINK. ANY ADVICE WOULD HELP.

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

I haven't been given a date yet for the pet scan. Here is what I know. the nodule was seen very tiny(?) 2 years ago. Last year it grew some but he did not sya it was spicualted. This year a bit bigget and spiculated. He is not worried , he says. not yet. I have rhemutoid arthritis very bad. I have asthma, have had really bad winter colds. I just had a very bad painful winter. was on prednisone twiceam now on hydroxychloroquine and 3oomg of gabapentin at night 1 hydroxych, in am. I also have brio, singulair, baby aspirin omeprazole and .5 lorazapam. I have symptoms of cancer yet not. Will pet scan answer once and for all? ALSO I believe he said it is solid, though he was wondering if i could cough it up. I never knew to try but last year i used to cough a lot and had much mucous i don't believe i brought it all up. Could this be that and calcified?

How are you doing? Any updates on your nodule?

I have spiculated 9mm nodule in the right upper lobe of my lung. PT scan Friday for further evaluation. I have history of endometrial cancer with one metastasis 8 years ago. I am concerned about the %80-90 malignant studies given the my history.
Any studies about spiculated scar tissue nodules?
My anxiety has been off the chart.

Thank you

Yesterday I saw a cardio/thoracic surgeon regarding my 9mm nodule in a middle lobe..Where it is located makes a biopsy impossible..It is spiculated with a solid component... I have never smoked..I have e-asthma..he advised he feels there is a 30% to 50% chance of it being cancer..It has been monitored over 5 years and grows about 1 mm a year..For now we both agree to continue to have Ct scans which is now 6 months away..it is what he said he would do if in my position as well..surgery always poses a risk and would certaintly take it out if that was my strong position...For now I am comfortable to wait and see if it grows over the next year..

I should also add that I had a Ct than a Pet Scan..Pet scan did show a SUV of 1.6..so anything over 2 would have been more concerning especially if over 2.5..
However SUV is not always the determining factor as to if cancer or not cancer.