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Noticed small nodules in the scan. Have slight density in left lower lung. what would be the next alternative step?

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in a recent screening ct(lung), it disclosed a 1cm nodule, other small nodules also noted. a pet scan with contrast show no hot spots,but inconclusive for lung cancer. suggested ct in XXXXXXX not happy with this. also for background, i am a retired radiology tech. 67 yrs. back in the late 1960's.while working in the clinic(multiple offerings) i came into contact with 3 active TB patients. positive ppd,follow chest x-rays, no meds. was told to not have skin tests ever 2001 a slight density in left lower lung was noted first. thought to be scar tissue.was noted off and on for several yrs. no mention of it in 2012. iam i smoker who is going through smoking cessation. also of note for 5 yrs in the 90's , our darkroom was improperly vented, the processor was vented directly back into the darkroom,instead of being vented to the outside. it also has been documented ,that this has caused lung cancer as well as other problems in techs. may it be noted that the 1cm nodule as shown on ct is not round and smooth. it has irregular borders, looks lobulated, and almost looks as if it may be encapsulated. all considered,i am not comfortable in waiting 3 mos. what would be the next alternative step? why not a biopsy? what is your take on this? XXXXXXX ivey
Posted Tue, 5 Nov 2013 in Cancer
Answered by Dr. Robert Galamaga 11 hours later
Brief Answer:
Nodule followup

Detailed Answer:
Hello and thank you for sending your question.

This is an excellent question and I will work on providing you with some information and recommendations.

From what you have sent it looks like you have a small nodule which has not revealed significant activity on the pet scan. this is not conclusive of any type of cancer but I do understand your concern regarding the possibility of either an infectious process or possibly some type of cancer going on.

I would doubt significantly that this represents tuberculosis. Tuberculosis typically would present with a larger cavitary lesion and we do not see that in your case.

I can certainly understand your concern regarding the irregular appearance or irregular borders of the nodule. If you maintain a significant degree of concern about this I would suggest that you sit down with your doctor and talk about possible options. Your doctor might consider asking and interventional radiologist to perform image guided sampling of this nodule.

this might help to put your mind at ease and might also confirm what the doctor suspects which is that this might be more of scar tissue or something which is not related to malignancy.

we usually do not necessarily biopsy tissue which is 1 cm or less in greatest size. The reason is because it can be very difficult for the radiologist to target such a tiny area.

in that sense many times we repeat imaging studies and three or six months or possibly even longer depending on the history of the patient.

you could consider discussing this with another general physician, oncologist or pulmonologist to see what they might recommend. It seems like you would feel more comfortable if a biopsy was performed.

thanks again for sending your question. Please let me know if you have any additional specific concerns.

Dr. Galamaga
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