Is a Spiculated lung nodule always malignant?

@democrite, I'm just checking in. I hope you received some additional information and have the details that you need. Did the additional appointment provide any helpful information? Have you made a decision yet on the biopsy or waiting for another scan?

Hello @milana, For reference, the SUV of my non-cancerous nodule was 2.3, the hilar lymph nodes had SUVs up to 7.2 on that same scan. I have a history of very active hilar nodes (in the middle of the chest). We are all different, and our bodies can react differently to cancer or infection, etc.
With the information that you've received now, it sounds like you have your decision made. Has surgery been scheduled?

Hi @lls8000 , thank you so much for your follow up. Surgery was yesterday 01/09, RATS and the surgeon did wedge/sleeve cut. Rapid biology tests showed no concern to remove middle lobe or lymph nodes,.there is something but it is not agressive, he said wait for biopsy in 10 days to know more, but he was reassuring.....my nodule was SUVmax 2.1. I have another nodule of 6-7 mm didn't light up on PET scan, not clearly defined, so for this one follow up in three months. Surgery went well, they will keep me 5 days ( herr in FR they keep you 5-7 days, depending on procedure and recovery, reading that in US is much shorter stay) but with the pain glad I stay here, as they control with pills and help a lot

@milana, Sending my best, good luck with your recovery! It sounds like you have good care. You are correct a 5-7 day hospital stay in the US is nearly unheard of unless there are complications.
Hoping you receive good news from your final pathology reports too.

Hi Lisa,
Thank you for checking in !
I saw a Pulmonologist 2ish weeks ago in the US. We decide together to delay the biopsy. I am currently finishing a 1-month antibiotics treatment (prescribe by the pulmonologist i saw in France). I'm having a new CT Scan on Tuesday morning, follow in the afternoon with an appointment with US pulmonologist (and probably as well her colleague biopsy Surgeon) and we will make the appropriate decision depending CT scan results = based on my understanding if (like French Doc says) nodule shrank due to antibiotics = infection = nothing and if nodule stable/bigger = Biopsy then more actions/surgeries depending results. It is still a very stressful situation "seating between 2 chairs" as we say in French but i guess I'm well handed by a team of professionals so voila. Thank you for your support and kindness

Thank you, Lisa, for your pleasant comments and also for suggesting the NET group!

Hi Lisa @lls8000
I saw my surgeon yesterday and had the pathology result yesterday confirming it is not a lung cancer. I was releaved, I could not beleave it. As I mentioned before, it was a spiculated nodule of 12-13 mm, that lid up on the PET scan, with an SUVMax was 2.1. The report states that piste is suspecting to be a Pulmonary Nodular Lymphoid Hyperplasia, a rare desease that sometimes shows spiculated nodules on CT scan. Other piste is a marginal zone lymphoma ( MALT lymphoma) . It is now sent for a second opinion in a institite that is more spesialized in pathology for lymph. So, good news it is not a lung cancer, bad news is, still not out of the woods.

@milana, thank you for sharing your update. You are in the midst of the ups and downs that many of us have faced. It's not easy, but these steps are necessary to find the best treatment.
There is a Mayo Connect group for blood disorders and cancers: https://connect.mayoclinic.org/group/blood-cancers-disorders/
And I did find a post related to MALT: https://connect.mayoclinic.org/discussion/recent-diagnosis-of-gastric-malt-non-hodgkins-lymphoma-and-am-requesti/
I hope you have more information soon.

Hello, It's Sept 2025 and I wonder how you are doing now? I have many of the same questions about spiculation of smaller nodules. I have 3-4 small ground glass nodules that were discovered a year ago on my first LDCT lung cancer screening. At the time they were all described as 4-5mm ground glass with indistinct margins. Now one year later there is no change in size but now describe smooth margins in all but one, one has "spiculated margins" It is 4.2mm ground glass. The recommendation was repeat scan in one year. My pulmonologist does not seem alarmed. My question is does anyone with similar situation, small spiculated nodule feel that one year is too long to wait to scan again? The first scan that had described the margins as indistinct in all of the nodules was reported by a different radiologist than the one that read the second scan. Could this just be a matter of reporting differences between two different readers or could the difference in describing the borders really represent a change or morphology of this one nodule. I have a follow up appt with my pulmonologist in 6 months and I intend to bring all of this up to her but as of right now she seems to follow the recommendation of the radiologist that I be re-scanned in one year. Thanks for any insight or replies. Hope you are in good health!

Hello, just checking to see what had come of the further evaluation of your 9mm spiculated lung nodule. I recently learned that one of my small ground glass nodules that was described last year as 4.2mm ground glass nodule with indistinct margins is now being described on this one year follow up scan as 4.2mm ground glass nodule with "spiculated margins" I am trying to see if this represents a true morphology of this nodule from last year or just a difference in reporting style or language. Scan last year was read by a different radiologist from the scan taken this year. So two different interpretations of same nodules? Or change occurred in one nodule? That has me anxious. Recommendation is re-scan in one year. My pulmonologist who went over the report doesn't seem concerned and is comfortable with a one year wait before scanning again. Was your 9mm spiculated nodule solid or ground glass. Was it discovered spiculated at 9mm or do they know it had been there on any previous scans and it changed? Thanks for your insight. Hoping this message finds you in good health!