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My wife has lung nodule, 9MM big, they want to do a biopsy with general anestheia, but they do not want to stop her daily aspirin because of other things she has had done, bypass, stents and carotid artery surgery, she doesn't want to be put completely out because of her breathing issues too, they suggested radiation without a biopsy or wait three months for another scan, i know they have newer radiation that can target a real small nodule with damaging surrounding tissue, whats the thoughts on this?
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Sorry you guys are going through this. Not a doctor, but here is how I see it. No Biopsy Means No Biomarkers
Without a tissue biopsy, there is no way to perform biomarker testing (such as EGFR, ALK, PD-L1, etc.). While SBRT is an effective targeted treatment, knowing the exact molecular profile of a tumor becomes critical if systemic therapies ever need to be considered down the road. Today's remarkable survival statistics are largely driven by these tests and companion targeted treatments.
Radiation Always Impacts Surrounding Tissue
Even though SBRT is extremely precise, treating any lung lesion with high-dose radiation creates localized scar tissue. If the nodule turns out to be non-malignant, she would be taking on a permanent, even if minor, loss of local lung function and capacity for a benign condition.
Because a 9mm nodule is right on the threshold where needle biopsies and PET scans can yield uncertain results, many care teams favor short-interval CT surveillance (monitoring for growth over 3 to 6 months) before committing to irreversible treatments like SBRT.
A liquid biopsy is also an option, though unlikely to return anything meaningful because the nodule is so small and sheds very little DNA. Still, there is a small chance it could pick up something.
Personally, I would push for tissue. Getting definitive answers opens the door to the best available personalized treatments should, God forbid, it turn out to be cancer.
Wishing her and your family the absolute best as you navigate the next steps with her care team.
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6 Reactionshi @tsillik - nodules are always worrying. sorry you and your wife are dealing with this health issue. there are 2 ways of doing biopsies on the lungs. one is a needle biopsy, but depending on the location and size of the nodule, they aren't always successful. the other is via a bronchoscopy with anesthesia (that is what I had). as @edivebuddy said, knowing tumor genetic biomarkers is critically important in lung cancer treatment today. if there's a way to swing it safely (not knowing your wife's health constraints) that's what I would recommend. you could also ask to have her case reviewed by your hospital's tumor board and see if they have any other suggestions.
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1 ReactionStereotactic radiation is a good choice. It doesn't damage surrounding tissue the way that external beam radiation does and it's done in fewer treatments. There's still a risk of pneumonitis but it's not as big a risk as with external beam radiation.
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2 Reactions@tsillik, Dealing with nodules is rarely straight forward. Each patient comes into this type of situation with different pre-existing conditions, tolerance for procedures, and guidance from the doctors.
If I understand correctly, we're not sure this is cancer, correct? Most nodules are not cancer, but some scans show characteristics that may point to it being cancer. The only way to know for sure, is the biopsy. If that comes with too much risk for her and your comfort level, her doctors should be able to discuss the risks/benefits of waiting or radiating. Would more time, waiting for another 3 months, help to make the decision?
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