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Is a Spiculated lung nodule always malignant?

Posted by darwin66 @darwin66, May 16, 2023

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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Mentor
Lisa, Volunteer Mentor | @lls8000 | 23 hours ago
In reply to @meliarg "Hello everyone, and thank you for replying and for all your good wishes for Mom. We're..." + (show)
@meliarg

Hello everyone, and thank you for replying and for all your good wishes for Mom. We're going through some very difficult days. We've received the results of the PET/CT scan. The 16mm nodule is solid, irregular, and spiculated, located on the periphery of the right upper lobe. It presented an SUVmax uptake of 2.88 and SUVmean of 0.60, with no other hypermetabolic findings in the lymph nodes or mediastinum. I thought this was relatively good news, as up until now I'd read SUVmax values of 5 or higher as indicators worth paying attention to. However, the doctors are determined to move forward with surgery; they tell us that a biopsy isn't an option as it might not be conclusive. This was yesterday. We were extremely anxious, as we were very excited to see what information the needle biopsy would provide (with faith that it was benign) and avoid a procedure as invasive as surgery. Everyone had told us about the importance of a biopsy. The first surgeon we spoke with at the time had told us that the area was accessible for needle biopsy. Her cardiologist, in turn, told her she had a low-metabolism lesion, so we can't understand why her pulmonologist would proceed with a bronchoscopy only to visualize the airways, lymph nodes, and mediastinum, as they say they don't think they can reach the nodule. The fact that they're recommending direct surgery with the intention of a lobectomy worries me. I can understand the urgency, but I don't fully understand the aggressiveness. Could you help me with your opinions or feelings? Does anyone remember her SUVmax values on the PET/CT scan? I really thought they weren't that high, but that's the problem with reading on the internet without having the resources to interpret... the last word belongs to the doctors. 😪🙏🏻

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@meliarg, These decisions can be difficult. The doctors are the experts and know your mother's case the best. It's hard when various doctors don't all provide the same recommendation from the start.
A relatively low SUV is better than a high SUV, but a low number can mean cancer too. They may not want to put your mother through a biopsy procedure, if they are confident that she'll need the surgery. But having a lobectomy without absolute certainly that I needed one would make me leery too.
It sounds like you need more info from the doctors to fully understand the need for surgery. Will you have an opportunity to ask more questions? How does your mother feel about the option of surgery?

REPLY
11moondog11 | @11moondog11 | 20 hours ago
In reply to @linpvc "thank you for your post. What exactly made your biopsies necessary." + (show)
@linpvc

thank you for your post. What exactly made your
biopsies necessary.

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The appearance of nodules on CT scan combined with medical history and risk/reward of taking biopsies all play a role in their decision to wait and see on a repeat scan or just go in and get biopsies.

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