Centers of Excellence

The Lung Center

Lung Nodules

Lung tissue is similar to a sponge, made up of tiny air sacs and blood vessels that function to supply oxygen to the body. A lung nodule is a solid area like a marble embedded in the sponge. Many things can produce a lung nodule: an enlarged lymph node, an old pneumonia or infection, phlegm impacted in a tiny airway or many other causes. Unfortunately, cancers can also produce and appear as lung nodules.

The risk that any nodule is cancerous depends most importantly on the size. In general, nodules that are less than 6 mm (1/4 inch) in diameter are followed with a repeat chest CT scan due to the low risk of cancer (ten percent or less), unless some other feature is felt to increase the probability of cancer. Nodules greater than 10 mm in diameter should be biopsied or removed due to the 80 percent probability that they are malignant. Nodules between 6 mm and 10 mm need to be carefully assessed. Nodules greater than 3 cm are referred to as lung masses.

The Lung Center at Brigham and Women’s Hospital (BWH) provides specialized diagnostic and treatment services for patients with lung nodules. Our board-certified thoracic surgeons are experts in video-assisted thoracic surgery (VATS), often done to biopsy nodules and determine whether they need to be removed.

Lung Nodules Topics

Causes of Lung Nodules

Lung nodules may be caused by:

  • Enlarged lymph nodes
  • Infections such as pneumonia or tuberculosis
  • Lung diseases caused by a fungus
  • Phlegm impacted in a tiny airway
  • Scars
  • Cysts
  • Lung cancer
Symptoms of Lung Nodules

The lung nodule itself rarely causes symptoms.

Diagnosis of Lung Nodules

If you have been told that you have a lung nodule, it is important that you bring a copy of the actual CT scan or chest X-ray (not just the written report) with you to your appointment at the BWH Thoracic Surgery clinic. These scans generally come on a CD/DVD. The scan will be uploaded to the computers in our clinic, and your surgeon will review the scan with you.

If additional testing is needed, your surgeon may also conduct the following diagnostic tests and procedures:

  • Chest CT scan uses a combination of X-rays and computer technology to produce detailed images of the bones, muscles, fat and organs. They may also be used to visualize placement of needles during biopsies.
  • Chest X-ray uses invisible radiation energy beams to produce images of any mass or spot on the lungs.

Repeat chest CT scans and chest X-rays are the most common way to follow a lung nodule. Sometimes PET scans are done. If repeated scans show that the nodule is unchanged in size after two to five years, it may be declared benign.

If the nodule has grown in size, if you are a smoker, have a strong family history of lung cancer or have developed symptoms of lung cancer, a biopsy may be done.

  • A lung biopsy may be performed using either a closed or an open method. Closed methods are performed through the skin or through the trachea (windpipe). An open biopsy is performed in the operating room under general anesthesia.
    • Needle biopsy: a thin, hollow needle is guided into the mass while the lungs are being viewed with a CT scan. A sample is removed and evaluated under a microscope. Also called a closed, transthoracic, or percutaneous (through the skin) biopsy. These may be limited by the size of the nodule (hard to do for very small ones) or location.
    • Navigational bronchoscopy: This new procedure creates a GPS-type guidance system combined with a bronchoscope to biopsy deeper and smaller spots in the lung.
    • Thoracoscopic biopsy, also referred to as video-assisted thoracic surgery (VATS) biopsy, makes a small cut in the side of the chest wall through which a tube with a video camera on the end is inserted. This is a surgical procedure necessitating a hospital stay that involves an incision in the skin on the chest and the surgical removal of a piece of lung. This allows the doctor to look at the outer part of the lungs and inner part of rib cage and to sample any abnormal areas for viewing under a microscope. Therapeutic procedures, such as the removal of a nodule or other tissue lesion, may be performed.
    • NIR image-guided surgery is a novel technique where small nodules can be injected with indocyanine green (ICG), a near infrared fluorescent dye. This allows for improved localization of nodules during VATS and at the same time allows for visualization of the associated lymphatics.
    • Image-guided video assisted thoracic surgery (IVATS) is a new technology developed at BWH which allows for a thoracoscopic biopsy, particularly for small nodules, to be done in a special operating room using live CT scans to localize the nodule and remove it more precisely.

Learn more about a BWH clinical trial utilizing CAT scans during surgery to better target lung tumors.

Treatment for Lung Nodules

The next step will depend on the size and radiographic appearance of the nodule. Your surgeon may recommend surgical removal or additional testing. The intention is to keep you safe from an undiagnosed cancer, while only recommending an invasive procedure if absolutely necessary.

What You Should Expect

When you become a patient of The Lung Center you will meet many members of the team who will carefully review your medical history and studies. In addition, you will receive a thorough diagnostic examination where you will receive a recommendation for a therapy tailored just for you based on your specific diagnosis.

Multidisciplinary Care

Patients with lung nodules benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, thoracic oncologists, pulmonologists, cardiovascular medicine physicians and thoracic imaging experts. This collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Any surgery recommended will be performed by an experienced, board-certified thoracic surgeon, in collaboration with a treatment team including nurses and physician assistants, all of whom specialize in taking care of patients with lung nodules. Your surgeon works in close collaboration with the experts in the Thoracic Oncology Program to tailor an individual treatment plan for you. Our specialized care team has some of the best results in the country. After treatment, routine life-long surveillance will be necessary.

Resources

Go to our online health library to learn more about thoracic diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

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