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Weigh risk before ignoring nodule

I obtained and read through a copy of the report of the CT scan I’d undergone in an attempt to identity whether or not a problem with my spleen (I have a blood disorder) could have anything to do with abdominal pain, left upper quadrant, that I’ve been experiencing for upwards of a year with increasing frequency. Spleen, stomach, pancreas and adrenaline glands appear normal. However, report mentioned “12 mm nonqualified left lower lobe pulmonary nodule. Follow-up advised.” Since the doctor said absolutely nothing about this notation in the report to me, am I OK to go ahead and disregard the impression?

Lung nodules are found with increasing frequency as chest CT scans become more common, faster and precise. The management of this finding is dependent on the risk factors for lung cancer, as well as the characteristics of the lung nodule and whether it is solitary or multiple. A single lung nodule that is less than 20 mm in size is more likely to be benign, or not a cancer. Other characteristics of a benign nodule include smooth discrete border, central calcification and no growth over time.

The risk of cancer increases with exposure to tobacco and certain work related exposures to asbestos, coal mining, or grinding of crystalline silica products. Additional factors to consider in deciding risk of malignancy include family history, advanced age and previous diagnosis of cancer.

Most nodules in this area are a result of exposure to histoplasmosis, a type of fungus that is prevalent in Indiana and surrounding states. A biopsy of these nodules would show a granulomatous reaction to a prior infection. Typically an infection with histoplasmosis is unrecognized and self-limited requiring no specific treatment.

Management of a single lung nodule depends on the above considerations. If there is low suspicion for cancer, then a repeat chest CT may be performed in one year.

The timing of the CT may be either three, six, nine, or 12 months. Another approach to a single lung nodule is to obtain a special scan called PET (positron emission tomography).

This study uses a labeled glucose molecule (FDG or 18-fluorodeoxyglucose) to look at the activity of the nodule. Increased activity suggests an acute infection or malignancy.

The test has certain limitations to consider when interpreting the results. For example, if the lung nodule is less than 10 mm in size, then there is a greater chance of a false negative result and greater likelihood of missing a cancer.

Dr. Jennifer Shaffer is a pulmonologist with Parkview Physicians Group. “Ask the Doctor” is a health column by doctors from Parkview Physicians Group. Send questions to Terri Richardson at The Journal Gazette, 600 W. Main St., Fort Wayne, IN 46802, or email trich@jg.net. Please put “Ask the Doctor” for the subject line.

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