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Lung Cancer

Follow up on lung nodules

04/24/2009

Question:

Went today to follow up again on a lung nodule that is slowly dissolving. The report read that it had spiculated edges. I thought those types of edges were more indicative of cancer? The report also mentioned something about density. What is that? I need to go again for a cat scan in four months. Will they keep repeating the scans till the nodule goes away? The doctor does not seem unduly concerned, just standard procedure. I`ve already had a neg. needle biopsy and the nodule has decreasing in size gradually. At what point do they stop following these?

Answer:

Although a spiculated nodule is more likely to be cancerous, it can also be infectious, especially in your case if it is resolving. The density of a nodule or mass is measured on CT images and helps us to understand if it contains calcified tissue (which in most cases indicates benign) or if it contains blood vessels or soft tissue like a tumor. If the nodule is decreasing in size it is most likely an infection. In patients with these nodules we usually observe for 2 years in 3-6 month intervals with repeat CT scans to determine if there is any change in size, shape or character, as most tumors double in size during this period . A negative needle biopsy is helpful if it is positive but does not completely rule out the possibility of cancer because sufficient tissue may not be obtained during the biopsy. So, your physicians preferred to observe with repeat CT scans. And in your case unless it disappears completely they will follow it for about 2 years. Thanks.

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Response by:

Shaheen  Islam, MD, MPH Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
Hematology
College of Medicine
The Ohio State University