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 may be caused by:
The lung nodule itself rarely causes symptoms.
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:
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.
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.
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.
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.
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