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Monday, July 28, 2014
Repeat CT scan for noncalcified nodule
A 5x7mm noncalcified nodule in lower left lung was detected on CT scan without contrast. Recommendation was to repeat the CT scan in 3 months. Is is best to have the repeat CT scan done at the same place? If there is any change in size, does that indicate a need for a biopsy? Also, please explain about "doubling time" and also when a CT scan is done with contrast versus without contrast. Thank you.
A 5 x 7 mm nodule is small, but it cannot be dismissed. The degree of concern for cancer is related to risk factors, particularly smoking and other cancers. I agree with the plan for follow-up. Three months is reasonable. It is ideal to repeat the scan at the same location, in order to compare the studies directly. If it is performed at another site, the original scan should be sent to the new site for direct comparison. If the lesion were to grow, a biopsy should be considered. Factors that would influence the decision would include its location, the growth rate, and other medical issues. Biopsy strategies include needle biopsy (typically guided by a CT scan), bronchoscopic biopsy, and wedge resection (best performed minimally-invasively by a general thoracic surgeon experienced with VATS). Doubling time is the length of time for a lesion to double in volume (not diameter)--a measure of growth rate. My opinion is that intravenous (iv) contrast is not typically required for evaluation of most lung lesions.
I would recommend that you see a lung specialist, either a pulmonologist or a thoracic surgeon.
Michael F Reed, MD
Assistant Professor of Surgery
College of Medicine
University of Cincinnati