Spiculated lung nodule found

Hi Zoe90, Welcome to Grace forums. I think we've communicated recently on reddit.  I've found NIH scan recommendations to share here with specific quote copied below.  Under Summary of Recommendations at 5.3.2. it suggestes nodules between 4 and 6 mm be rescanned between 6 and 12 months, and nodules 6-8 mm be rescanned between 3 and 6 months.  Perhaps you can speak with the pulmonologist about your concern with the shape of the nodule and waiting 6 months to rescan.  The nodule is too small to biopsy and resection would be considered too risky.  If you were to find a balance between the its small size and spiculated shape then 6 months would fit in that space.  And the insurance co, if you are in the US might say as well.  Since every case is individual and there are 2 competing issues (size and shape) a 2nd opinion from an academic center with a specialty in lung cancer would help.  (prob more likely to get an appointment with a pulmonologist, most oncologist at academic centers only see people with a cancer diagnosis)

I hope everything goes well. Keep us posted,

Janine

Summary of Recommendations

5.3.2. In the individual with a solid nodule that measures ≤ 8 mm in diameter who has one or more risk factors for lung cancer, we suggest that the frequency and duration of CT surveillance be chosen according to the size of the nodule (Grade 2C):

• Nodules measuring ≤ 4 mm in diameter should be reevaluated at 12 months without the need for additional follow-up if unchanged
• Nodules measuring > 4 mm to 6 mm should be followed sometime between 6 and 12 months and then again between 18 and 24 months if unchanged
• Nodules measuring > 6 mm to 8 mm should be followed initially sometime between 3 and 6 months, then subsequently between 9 and 12 months, and again at 24 months if unchanged.

Remark: For the individual with multiple small, solid nodules, the frequency and duration of follow-up should be based on the size of the largest nodule.

Remark: CT surveillance of solid nodules ≤ 8 mm should use low-dose, noncontrast techniques.

Hi Zoe90,

There are too many times when there are no cut and dry answers to our questions.  Often it's because the details are specific only to the individual.  That's why I'd want to see or consult with a doctor with all your info, has expertise, a top notch team, who makes similar diagnoses every day, and who welcomes people who want to understand and be involved in the decision making process.  That is the person who can best help with deciding the best follow-up approach to a 5mm speculated (small but suspicious) lung nodule. The best place to find a pulmonologist like that is in a large academic center with expertise in lung cancer.  Today you can get a consultation over the phone or Internet, especially since covid. 

The links below suggest a nodule smaller than 6mm should be rescanned in 6 months.  I doubt any healthcare system would pay for a scan earlier, including US insurance subscribers...unless a doctor felt there was a good reason to ask the insurance company to authorize for earlier. 

This links to a tiny retrospective study concluding, "Conclusions: Patients with sub-centimeter lung adenocarcinoma have a relatively earlier onset age. Sub-centimeter lung invasive adenocarcinoma patients with 6 mm-10 mm mGGN and 6 mm-10 mm SN may be involved in pleural invasion or lymph node metastasis. Smoking history, previous tumor history, mGGN, SN and tumor diameter >5 mm are independent risk factors for sub-centimeter lung invasive adenocarcinoma. For patients with sub-centimeter lung adenocarcinoma, early detection and appropriate surgical intervention can lead to a good prognosis."

I can't speak to the author or doc of your link quoted in it, but I do trust Dr. Pennell.  He used to contribute to our forums and is Vice Chair of Clinical Research and Director, Lung Cancer Medical Oncology Program Cleveland Clinic Taussig Cancer Institute.  In this thread, he stated, "As for your CT scan showing a 5mm nodule, probably half of people out there have similar tiny nodules and almost all of them are not cancer (over 95%),...The guidelines for a 5mm nodule would indeed be to repeat the scan in about 6 months so I think that is reasonable."

I hope I was able to put that back together in a manner that makes sense.  Let me know and take care,

Janine