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1 cm lung nodule, needle biopsy, concerns???
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1 cm lung nodule, needle biopsy, concerns???

I am posting for my 79 year old mother.  Generally good health, non-smoker or drinker, obese, some shortness of breath over 2-3 years and some coughing in nights or morning.

She had been out of energy for awhile and the doctor did a full body x-ray and found a spot on her lung.

They then did a CT scan of the chest.  The findings showed a non-calcified lesion in the right upper lobe.  This has indistinct margins with suggestion of minimal spiculation.  It measures 1 cm. in dia.  Review in mediastinal windows shows no hilar or mediastinal or axillary adenopathy.  The heart and great vessels are normal in appearance.  There are some calcified nodes seen in the left infrahilar region and minimal calcific atherosclerosis in the arch.

They suggested a PET CT scan which she had done.  (The technique was intravenous 15.8 mCi F-18 FDG.  Blood gucose at time of injection was 110 mg/dl.)

The results (chest) were a mild increased FDG uptake in a 1 cm. pulmonary nodule in the right upper lobe the maximum SUV value of 2.3.  There is no abnormal uptake within the lymph nodes.  The remainder of the lung fields are clear.

The Baseline Study was: Mild increased FDG uptake in a 1 cm. right upper lobe pulmonary nodule.  This finding is indeterminate for neoplasm.

CHOICES:  The doctor explained (somewhat inadequately I think) she could do a needle biopsy or wait 3 months and do another CT scan.  I have tried to read up on needle biopsy's and am trying to understand what a 3 month wait could mean in terms of cancer (if it was).  How does one decide?  My mother wants to wait but I am of the opinion that the sooner the better (do the needle biopsy).  I am trying to gather information before I discuss this in depth with her.

Thank you very much for any assistance.

David
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Hi David,
Nuclear medicine based tests like PET scanning show metabolically active lesions in the body. This activity may be caused by many conditions, including cancer, infection, inflammation, etc.
In your mothers case, there is a small nodule, some spiculation is also seen on CT, and it shows some uptake by FDG PET also. It is better to rule out cancer quickly.
One way forward could be a CT guided FNAC (fine needle aspiration cytology), which is less invasive, less painful, and gives nearly equal clinical information as compared to a biopsy. An FNAC will probably give us enough clues to plan the next steps.
All the best, and God Bless!
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