spiculated lung nodule found

[Gillianmillian]

Hello, I’m new here and hope I can get some advice and support. I live in Germany, so sorry in advance for my English. 
I’m a male 58years nonsmoker, high blood pressure, asthma and allergies.

I have had a dry cough, hoarseness and urgent to clear my throat, shortness of breath for over 2 years. At the beginning of this year I went to a Pulmonologist to get it checked and got diagnosed with asthma which is now treated with medication. My doctor still ordered a CT scan which Showed 5 solid lung nodules The nodules are between 4-5mm in size, One of the nodule is spiculated, next Ct scan will be in 6 months. The nodules are too small to do biopsy or Petscan, so the approach is to just watch and wait for now.
I‘ve done alot of research and all studies and data I’ve found, state that Spiculated lung nodules are malignant in 90% of the time, So the likehood of if it being cancer is very high, I’m very concerned.

My Ct report

Findings:

1 subpleural laterobasal lung nodule on the right

1 lung nodule is spiculated and in the middle lobe on the right

2 completely calcified nodules upper lobe on the right

1 Atypical perifissual nodule, 1 micronodule on the right

1 typical perifissual upper lobe on the right

No detectable enlarged lymph nodes mediastinally

No pleural effusion. No bone changes suspected of being malignant

Impression:

A total of 5 solid lung nodules on the right under 5 mm, 2 which are perifissural, one typical and one atypical - further CT control in 6 months

Two calcified lung nodules in the right upper lobe, most likely granulomas

 

[LouT]

Welcome to our forum.  I'm glad you found us.  As a lung cancer survivor, I fully understand your concern about nodules.  After researching on spiculated lung nodules I believe I found the article you referred to and you likely misinterpreted the information.  It does state that "90% of malignant nodules are spiculated".  But it also says that "2/3 of all benign nodules (which make up 90% of all nodules found) are spiculated".   I realize it's a lot of math to do, but even spiculated nodules are more likely to be benign than malignant.  Your doctors are wise to wait and watch.  They will likely look for changes and/or growth for any of the nodules before ordering a biopsy; which is the only true way to know if a nodule is malignant or benign.

I get that finding anything in our lungs is upsetting, but until you get any more proof that this nodule (spiculated or not) is malignant please try and stay calm.  Right now the odds are with you.  Please keep us updated and ask any other questions that you may have.

Lou

[Gillianmillian]

23 hours ago, LouT said:

Welcome to our forum.  I'm glad you found us.  As a lung cancer survivor, I fully understand your concern about nodules.  After researching on spiculated lung nodules I believe I found the article you referred to and you likely misinterpreted the information.  It does state that "90% of malignant nodules are spiculated".  But it also says that "2/3 of all benign nodules (which make up 90% of all nodules found) are spiculated".   I realize it's a lot of math to do, but even spiculated nodules are more likely to be benign than malignant.  Your doctors are wise to wait and watch.  They will likely look for changes and/or growth for any of the nodules before ordering a biopsy; which is the only true way to know if a nodule is malignant or benign.

I get that finding anything in our lungs is upsetting, but until you get any more proof that this nodule (spiculated or not) is malignant please try and stay calm.  Right now the odds are with you.  Please keep us updated and ask any other questions that you may have.

Lou

Hello LouT,

Thanks for your answer, It is very helpful. Can you please send me the link.

If 90% of malignant lung nodule are spiculated it is very likely that my lung nodule is also malignant. Every data and studies I found, describes spiculated lung nodules to be very suspicious of malignancy. With a predictive value of 90%. I asked a few radiologist on the internet regarding spiculated lung nodules, for them spicula is like a sure sign of the nodule being cancerous. Benign cases are a exception but not the rule when it comes to spiculated lung nodules. Although there are rare cases such as infection, scarring, or other benign causes that can mimic a spiculated nodule, the chances of it being benign are generally very low.

I‘ve also spoken to few people who had spiculated lung nodules and unfortunately in almost all cases it turned out that they were malignant. That’s why I’m really concerned. 

[LouT]

Gillianmillian,

You may be misunderstanding the data...I've included the link here.  While spiculated nodules make up the majority of malignant nodules, the fact is that 2/3 of BENIGN NODULES also have spiculation. I'm not saying that a spiculated nodule can't be malignant, but the article states that the majority of nodules are benign and up to 2/3 of those benign nodules can have spiculation.  

My  counsel is to follow your doctor's advice and then be rescanned and if there is any further doubt about the nodule then have a biopsy.  That is the only valid way to determine malignancy.  

I hope this helps.

Lou

[Tom Galli]

Gillianmillian,

I'll add my welcome to Lou's.

Spiculation is a characterization, or description, of the appearance of a nodule in a CT scan. It is not a diagnosis. As Lou points out, a tissue biopsy and histology examination by a pathologist is the only way we can diagnose lung cancer currently.

I completely understand your concern. Having an unresolved CT that shows something but explains nothing is maddening. But after almost 20 years of scans, I still get CT results reporting spiculated lung nodules. I was pronounced no evidence of disease (NED) in March 2007 after more than 3 years of continuous treatment resulting from a diagnosis in February 2004. I also have nodules that appear and disappear from scan to scan. To ease my uncertainty about these phantom nodules, I plot their location on a spreadsheet using the anatomical description in the radiologist's report. When I get a scan indicating a "new" nodule, I have the data available to address my apprehension.

I do hope your spiculated scans turn out to be nothing. If not, you've found us, and while none of us are physicians, we are all subject matter experts with extensive experience in diagnostic and treatment methods.

Stay the course.

Tom

 

[LilyMir]

Hi, from what I gathered during my diagnosis process, spiculated is bad news  most of the time if the lesion is large. If the lesion is small, there is still a fair chance it is benign. I know how hard it is to wait for answers but try to remain hopeful it is not cancer, but if it is, you would have caught it rather early, which is usually very good news. Under 5mm is small. Mine was up to 2.5 cm in one dimension when radiology spotted it (was much smaller but missed on a scan years earlier!). I remember using an online risk calculator when I was waiting for answers but I recommend you don't as it won't really give you an answer, only biopsy will. Best of luck!

[Karen_L]

Welcome! I can add only that in the U.S., if patients remain unsettled after a consult with a doctor, they are urged to seek a second opinion, from an oncologist who specializes in lung cancer. The field is changing at such lightning speed that a general oncologist cannot keep up. 

Me and my nodules wish you lots of luck in the stage of waiting and wondering (and worrying.)

[Kamoto]

Karen speaks the truth.  My oncologist was on the team who trialed Tagrisso while he was w Denver's Jewish Hospital.  His initial speculation was EGRF mutation and it most certainly was.  But when I informed him that I was getting a 2nd opinion from Mayo Clinic in Rochest MN, he welcomed it, as he was having to deal with every cancer as the single oncologist here in Bozeman MT.  He told me he couldn't keep up with advances in Lung, but that Mayo has probably fifteen specialist who only deal with lung.  Mayo Clinic agreed to his entire treatment plan, and offered nothing else they would recommend.  Why won't they do a biopsy?  My lung tumor on CT scan was 3.5 MM and they ordered a biopsy.  Once they determined EGFR mutation and malignant, they ordered the PET scan, which I lit up and they staged me at Stage IV with mets on the rib, brain, and back, as well as a seperate Stage II esophagus cancer.  People say US Medicine is terrible, but when you have corporate insurance, US Medicine is best in class.  Get the 2nd opinion in Germany or if you can afford it, fly into Mayo Clinic in Rochester MN who is setup for international patients.