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I was diagnosed with COPD (severe emphysema) in 2014. Had a routine CT scan done 11/26/17 where a 9mm left apical speculated nodule was seen. PET/CT recommended. PET impression read, solitary speculated left apical nodule is hypermetabolic and likely malignant. Tissue diagnosis recommended. I was given the PET results at the end of the year and due to an insurance change had to find a new pulmonologist to order the biopsy. I am scheduled to see him on the 20th and the waiting is driving me mad.

I have been researching types of biopsies and there is very little I could find about the additional risk due to having COPD. Not sure which type would be best for me. Also, are the scan results positive it is cancer and the biopsy is for identifying and staging purposes? Hoping someone can give me some guidance. I am pretty scared.

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Hi Tamara,

Welcome.  I am not an expert on biopsies, but I can tell you about my mom's experience with them.  My mom did (past tense) have COPD, the majority of it was in her right, upper lobe (her upper right lobe was removed as part of her cancer treatment).  This was also where her nodules were.  She had a regular needle biopsy (there are a couple of different types of biopsies) - she had no issues at all besides a sore throat for a few days.  Initially her pulmonologist was worried about her breathing during the procedure just because she had COPD and was severely overweight, but all went extremely well and she was in and out in a matter of a few hours. There are always higher risks for folks with COPD in any situation where they are sedated, but good pulmonologists and anesthesiologists are used to dealing with the challenges of COPD.   

As far as scan results being positive it is cancer - all that the PET scan is telling you is that there is a something there and it is "active" - nodules can be active and not be cancerous.  The only way to know for certain if a nodule is cancerous is through a biopsy.  As far as staging goes, all aspects of the possible cancer situation is taken into consideration - size, area, has it traveled elsewhere, etc.  The nice thing about biopsies is that they can be tested for a variety of mutations that can lead to more options for treatment - immunotherapy, etc.  

I am so sorry you have to wait for your biopsy, especially due to the ridiculousness of insurance :(  The waiting seems to be the worst part, especially in the beginning.  I am sure you will hear from others very soon who will be able to better share their wealth of knowledge about the topic. In the meantime, you can check out what lungevity has to share about biopsies and staging: https://www.lungevity.org/for-patients-caregivers/lung-cancer-101/diagnosing-lung-cancer/biopsies   and   https://www.lungevity.org/for-patients-caregivers/lung-cancer-101/lung-cancer-staging

Take care,

Steff

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Tamara,

Steff's information on biopsies and staging is spot on.  

I completely understand your fright.  My diagnosis and treatment were very frightening times.  That said, in 23 days, I will celebrate my 14th year of survival with advanced stage, metastatic non-small cell Squamous cell lung cancer.  I relate that fact because if lung cancer is confirmed by biopsy, if I can live, so can you.

You are most welcome here and we are happy to address any questions you may have.

Stay the course.

Tom

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Hi, Tamara, and welcome!  I don't have any input on the issue of biopsies (I went straight to surgery and cancer confirmed during surgery, resulting in upper left lobectomy), but you'll get good info from the other folks here.  I know how tough the waiting is--hang in there!  The good news is that your nodule is still pretty small, which is always a good thing.

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Hi Tamara

My husband has severe COPD and was able to have a needle biopsy without any problems.  These type of patients have higher risks but the team at the hospital was great and everything went well without any issues.  Hopes this helps

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