Lung nodule

Had arrythmia in December.  Cardiologist sent me for sleep apnea study after stress tests found nothing.  No sleep apnea but Restless leg syndrome and low oxygen level at night. Sent to Pulmonary doctor who sends me for function tests which were inconclusive but low effusion rate.  Could be mild COPD.  Former smoker quit 12 years ago (I am 53).  Dr. sends me for CAT scan with contrast.  CAT scan shows one small nodule which was not visible on several chest xrays.  I was given 3 options.  1 wait for 6 months to see if the nodule grows.  2 have biopsy done. 3 have PET/CAT done.  I chose option 3 because I am scared. Insurance initially denied.  Physician appealed and got approval.  I am scared.  All these tests due to low oxygen.  I don't feel ill.  I have always had trouble breathing during exercise - quit field hockey in 6th grade.  I am scared and want some reassurance.  Is it good that the nodule was not visible in the xrays but only in the ctscan?  Better prognosis?  

[David S. Wilson, MD, FCCP]

There are 2 problems here.  First, it is very important that your lung nodule is evaluated properly.  The size of the nodule is really very important. Generally , nodules less than 8mm are low risk and are monitored by repeat CT.  PET scans are not very accurate with nodules less than 10 to 15 mm.. Nodules greater than 8mm with your smoking history probably justify considering some form of biopsy.  The emergence of a technique called Electromagnetic Navigational Bronchoscopy has made these biopsies safer and more accurate.  Needle aspirate biopsies are falling out of favor due to the 30 percent rate of lung collapse and surgery is usually avoidable. secondly, it sounds as if you have the start of problems with COPD and should be evaluated by your physician with pulmonary function tests.  A useful web site for the nodule discussion is spotonyourlung.com