6mm Growth in 3 Months - 1294918

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peterc037
6mm Growth in 3 Months - 1294918

Hi,
A CT scan has just shown a 6mm fissural nodule in my lung. Three months previous to this there was no nodule on a scan. Over the last 2 years I have had 4 scans which did not show this nodule, I am confident it is a new finding.
From what I know, 6mm would be too small to biopsy. It would seem that the standard is to rescan after a period of time. My concern is that zero to 6mm represents rapid growth and a 6 month, or even three month follow up might be inappropriate.
Is there any protocol for this type of scenario?

I have been suffering from extreme tiredness and some muscle loss.

Regards

Peter

JimC
Hi Peter,

Hi Peter,

Welcome to GRACE. I am sorry to hear that your scan finding is causing you such understandable concern and worry. It is important to know that many people have such solitary nodules, and the majority are not cancerous. Dr. West discusses the imaging features which make such nodules more or less suspicious for cancer in this post. At the end of his post, there are links to other posts which may provide relevant information for you.

One thing to stress is that a 6mm nodule is extremely unlikely to cause the symptoms you describe.

For such a small, single nodule, it's pretty typical to scan in 3 to 6 months to check for growth. I understand your desire to scan sooner, but with a shorter interval, it can be difficult to detect any change on the scan, and an unchanged nodule can look somewhat different on successive scans, due to slight differences in scan angle, and the way the images "cut" (since a CT is made up of multiple images).

I understand your concern, so it is difficult to suggest that you not worry about this finding. But try not to conclude the worst, as many of these nodules are harmless.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

onthemark
Hello Peter,

Hello Peter,

Welcome to GRACE. It's understandable to be worried about a growing, albeit small, nodule. Can I ask, why were yougetting scans so often (4 in the last 2 years) and what else may be on the scans, besides this nodule that would prompt such frequent scanning or concern?

onthemark
Hi Peter,

Hi Peter,

I'd just add to Jim thoughtful post by asking why you were scanned four times in the last two years and what else might be on the scans that could prompt a concern, if anything.

Is it just a solitary nodule?

For protocol, from the "Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017"
https://pubs.rsna.org/doi/full/10.1148/radiol.2017161659

"For solitary solid noncalcified nodules measuring 6–8 mm in patients at high risk, an initial follow-up examination is recommended at 6–12 months and again at 18–24 months (grade 1B: strong recommendation, moderate quality evidence). This recommendation is based on an estimated average risk of malignancy of approximately 0.5%–2.0% for nodules in this size range and is derived from screening studies, most notably the PanCan, BCCA, and NELSON trials (6,7) Again, the precise intervals can be modified according to individual risk factors and preferences. In some patients in whom nodule stability remains uncertain, further surveillance may be required; however, two follow-up examinations should be sufficient to exclude growth in most subjects."

peterc037
Hi,

Hi,
Thank you for the welcome. I was scanned 4 times as they were monitoring an aneurysm. So it was a shock to get this finding. At least I am confident that it is appropriate to wait, I have been sweating over this the last few days.
I feel more relaxed already.

Regards,
Peter

onthemark
Hi Peter,

Hi Peter,

One day, hopefully in the not too distant future, there will be blood or breath tests for lung cancer but at the moment the only alternative in your situation is to watch and wait for 3 to 6 months. It can take several months for local inflammations that can lead to nodules such as yours to resolve. I would lean toward 3 months since the lesion appeared on that time scale and try not to worry too much in the meantime. It is likely not cancer, but needs to be watched.