How large must a nodule be in order to have a biopsy?

[Moogy]

I heard back from a pulmo doctor today, and I don't really understand the advice. I am hoping some of you experienced forum members can enlighten me.

I had called to ask for an appointment for a consult on whether it would be a good idea to have a biopsy for my dad. Papa(age 90) has emphysema (50% lung capacity) and had prior lung surgery (1998, had top lobe of right lung removed due to cancer). Papa recently had a troublesome CT scan.

The doctor reviewed my dad's CT scan, which showed "at the left apex, there is a 9 mm spiculated nodule noncalcified highly concerning for metastatic disease. Management options would include a percutaneneous biopsy or follow up chest CT in three months."

The pulmo doctor had his staff member call to say we should wait for the 3 months to see if the nodule increases in size, and that it is too small for a biopsy right now.

How large does the nodule have to get before a biopsy is possible? If it isn't possible at this point, why did the radiologist list biopsy as an option?

Doesn't "highly concerning" mean there is a probability that this is actually malignant?

Are there other diagnostic tests that could be done now, and what kind of specialist should we visit to see what our options are? I am considering going to a major cancer center, but I would prefer to get a second opinion locally before that.

I am uncomfortable taking advice from a doctor who only reviewed the CT scan, who doesn't even know my dad's history, etc.

I am also uncomfortable just "waiting" since my father-in-law had a fast moving type of cancer, and when it was discovered, it was too late for any treatment.

Papa is not going to want any extreme measures, given his advanced age, but if there are treatments that could give him a bit more time without a lot of side effects, he might want to try them.

[RandyW]

Several Links that I found that may help;

Basics of Diagnosing with a few alternatives;

http://www.lungdiseasefocus.com/lung-ca ... biopsy.php

This MAy be exactly what you are Looking For right now, I think

http://icscreen.med.cornell.edu/ielcap.pdf

And THis one may help

http://www.guideline.gov/summary/summar ... 1&nbr=4133

Let me know if this helps or not. If Not can do a little More Digging. Sending Prayers.

[Welthy]

Moog,

Go to Onctalk.com and ask Dr. West about these issues. He is affiliated with this community and an amazing resource for all of us.

My only other thought is a PET scan.

Best wishes,

Welthy