Is a Spiculated lung nodule always malignant?

Hello @linpvc, some nodules are difficult to biopsy when they are deep in a lower lobe or it may be too dangerous to biopsy depending on the proximity to the heart or certain arteries. Pulmonologists are getting better at reaching difficult nodules through the use of robotic bronchoscopy, allowing greater access to the entire lung. (https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/robotic-assisted-bronchoscopy-faq)
I hope your appointment goes well next week. Did they respond to your message requesting a biopsy?

it is located on RML on lung base on Pericardium surface
just returned from doctor. it is spiculated, slightly, he says no thoracic surgeon would biopsy it because of its location. so instead of biopsy, he will watch its size. ill have a cat scan in six months. if it grows he'll take as a sign of malignancy and ill need to have the nodule removed by open-heart surgery or hopefully VAT.
i told him of a blood test, Nodify XL2 and Nodify CDT
MY healthcare provider doesnt have it but it is out there and the doctor Googled it. he is researching it for me. i want it as it detects lung cancer even if in-situ. i've requested it.
have you heard of it

@linpvc, That sounds like a difficult location, and the care that they are taking with your situation is certainly warranted. I can understand why the traditional biopsy that a pulmonologist would perform is too risky.
I hadn't heard of the Nodify XL2 test. I'll be interested to hear what your doctor thinks about it. There are tests that measure the CTDNA (circulating tumor DNA) in your blood stream. General biomarker testing can be done in this way, through a 'liquid biopsy' using blood instead of tissue. Those tests only work if the nodule/tumor are shedding enough cells for the test to pick up on it. Even though these tests can save lives, some insurance companies push back on paying for these types of tests, and they can cost thousands of dollars, so check on that too.
How do you feel about waiting 6 months for your next scan?

@linpvc, That sounds like a difficult location, and the care that they are taking with your situation is certainly warranted. I can understand why the traditional biopsy that a pulmonologist would perform is too risky.
I hadn't heard of the Nodify XL2 test. I'll be interested to hear what your doctor thinks about it. There are tests that measure the CTDNA (circulating tumor DNA) in your blood stream. General biomarker testing can be done in this way, through a 'liquid biopsy' using blood instead of tissue. Those tests only work if the nodule/tumor are shedding enough cells for the test to pick up on it. Even though these tests can save lives, some insurance companies push back on paying for these types of tests, and they can cost thousands of dollars, so check on that too.
How do you feel about waiting 6 months for your next scan?

I started out on my lung cancer journey in 2017, I asked for a ct scan because I had quit smoking 5 years and I read an article urging ex smokers and even smokers to get a cat scan just to be sure that nothing is wrong. I had numerous nodules but one nodule was spiculated and about 9mm..it was decided that they would keep an eye on it with routine scans, so 3 years later it became cancer and grew a little, another small nodule popped up and it was decided to do a lobectomy, no chemo was needed because nothing had spread to lymph nodes. I had a second one almost 2 years later and it was removed by taking a wedge of lung, I couldn’t have another lobectomy due to poor breathing from copd, I am currently a four year survivor and very happy to be alive, this is all owing to early detection and it’s saving lives. It’s terrifying to walk around with these things but somehow you find the strength to keep you going and connecting here with people who really understand how you feel, I’m trying very hard to stop living my life with fear as my companion, I don’t have the strength anymore to entertain my mind with horrible thoughts which has done more damage to me than anything else. Please tell yourself that you are in a safe place because you know what’s going on inside and that’s more important than not knowing, sending you lots of strength and positive thoughts in your journey.

Thanks for sharing your story.
Glad they caught it early and you're doing well! Hoping for continued health for you.
Do you happen to know what kind of nodule the spiculated one was? was it solid, semi-solid, or ground-glass? My nodule is solid, and the doctors told me they typically just monitor those for about 2 years. After that, they usually determine them to be benign and stop the CT scans. But with ground-glass and semi-solid nodules, they tend to monitor for up to 5 years or more.
So I'm assuming your nodule must have been either ground-glass or semi-solid, since they were monitored for longer than 2 years.

It was also semi solid and by three years of ct scans it became solid.. I was then given a pet scan and it was definitely confirmed that it was cancer. I remember that a small nodule showed up beside the original nodule and they later determined that it was a different cancer, this scared me a lot because I had no idea you could have two different cancers in one place.