Respirology Case Reports | APSR Respiratory Medicine Journal
Benign Lung Nodules: Symptoms, Causes, And Treatment
Benign lung nodules can have a few different causes. These include current and past infections in the lungs and inflammation in the body from a condition like rheumatoid arthritis.
A lung nodule is a small growth in the lung that's less than 3 centimeters. Most are benign (noncancerous) and don't cause any symptoms.
Most lung nodules aren't a cause for concern, but your doctor may wish to monitor a nodule with regular CT scans for a few years to see if it grows.
Roughly 95% of people with a benign lung nodule that shows up on a diagnostic scan don't have any symptoms. If you do have symptoms, they're usually related to an underlying condition causing the nodule.
Following a CT scan, a doctor may be able to differentiate between a benign (noncancerous) and malignant (cancerous) nodule by its size and shape.
Benign nodules are usually round, smooth, smaller than 8 millimeters (mm), without a defined border, and calcified (hardened with calcium).
Malignant nodules are typically larger with a well-defined border, bumpy (lobulated) or spikey (spiculated), and irregularly shaped. They also tend to be present in the upper lobes of the lungs.
You can have one lung nodule (solitary lung nodule) or multiple nodules.
Benign pulmonary nodules can be due to inflammation from a number of conditions, including:
The most common cause of a benign nodule is a previous infection. In some cases, the cause of the lung nodule is unknown.
Lung nodules after COVID-19
Research suggests that 3–12% of people with COVID-19 infections have nodules on their CT scans.
Doctors discover most lung nodules incidentally during a CT scan or chest X-ray for another reason. They show up as white spots on the scan.
According to the American Thoracic Society, doctors find nodules in up to half of adults who get a chest X-ray or CT scan.
Most small lung nodules are benign and won't ever become cancerous. But it's possible for a benign lung nodule to become malignant over time.
A malignant nodule is more likely to occur:
If you have any of these risk factors, your doctor may want to monitor your nodule over time to see if it grows. Nodules smaller than 6 mm usually don't require routine follow-up.
A nodule that grows over time could mean it's malignant.
To diagnose a malignant nodule, a doctor may take a sample of the nodule (biopsy) to examine it under a microscope. Doctors don't usually recommend biopsies when nodules are small.
Benign lung nodules usually don't require treatment or removal. A doctor may order additional CT scans over the course of several months or years to monitor for any changes in the size of the nodule. This is known as active monitoring.
If nodules grow large enough to cause symptoms or are cancerous, a surgeon may need to remove them.
Benign lung nodules usually don't grow. Even if they're malignant, they'll grow fairly slowly.
It takes several months for a nodule to get bigger. It's considered safe to wait a few months for the next CT scan. Waiting shouldn't affect your treatment or chances for a cure if the nodule turns out to be cancerous.
Here are answers to some frequently asked questions about benign lung nodules.
Can you have lung nodules that aren't cancer?
Yes, you can have lung nodules that aren't cancerous. In fact, more than 95% of lung nodules are noncancerous (benign).
Is it normal to have benign nodules on your lungs?
Benign pulmonary (lung) nodules are fairly common. Doctors find them in up to half of adults who get a chest X-ray or CT scan.
What are the odds of a lung nodule being cancerous?
Fewer than 5% of lung nodules turn out to be cancerous.
When should you worry about lung nodules?
Most lung nodules are benign and not a cause for concern. If the nodule gets larger over time, it could be a sign of cancer.
Can lung nodules disappear on their own?
Do doctors need to remove benign lung nodules?
Benign lung nodules usually don't require treatment or removal. A doctor may recommend surgery to remove a nodule if it grows over time or becomes cancerous.
Benign lung nodules are small growths that form in the lungs. The vast majority of lung nodules aren't cancerous, and most don't cause any symptoms or require treatment.
If your doctor finds a nodule on your lung during a CT scan or chest X-ray, they may recommend follow-up scans to see if the nodule gets bigger over time.
Molecular Profiling Of Precancerous Lung Lesions Could Lead To Early ...
The world's first genetic sequencing of precancerous lung lesions could pave the way for very early detection and new treatments, reports a new study led by UCL researchers.
Before lung cancer develops, precancerous lesions are found in the airway, but only half of these will actually become lung cancer, while others will disappear or remain benign without becoming harmful. Under the microscope, the lesions look the same, making it difficult to know which lesions to treat.
In this study, published in Nature Medicine, researchers have for the first time, discovered the differences between the lesions that will become invasive and those that are harmless, and they can accurately predict which lesions will become cancerous.
"Our study helps to understand the earliest stages of lung cancer development, by figuring out what's going on inside these cells even before they become cancerous," said the study's lead author, Professor Sam Janes (UCL Division of Medicine and University College London Hospitals, UCLH).
"Using this information, we may be able to develop screening tests, and new treatments that could stop cancer in its tracks."
The researchers were studying biopsies of preinvasive lung cancer lesions of patients who were seen at UCLH. They conducted tests including gene expression profiling, methylation profiling, and whole-genome DNA sequencing on 129 biopsy samples from 85 patients.
On average, the patients were followed up for over five years post-biopsy, to see which patients developed lung squamous cell carcinoma, one of the two most common subtypes of lung cancer.
The research team identified differences in genomic features such as mutations, gene expression and chromosomal instability, finding enough differences that they could predict with near-perfect accuracy which lesions would develop into cancer by checking the lesion's molecular profile.
By identifying which precancerous lesions are harmful, the researchers say clinicians could decide whether or not to offer a patient surgery at a much earlier stage of the disease than is currently possible, while saving others with benign lesions from unnecessary surgeries.
Precancerous lesions are detected by bronchoscopy, a minimally invasive test that is often done on people with chronic cough or a history of lung cancer.
There is no consensus on treatment for precancerous lung lesions; in some countries, patients with such lesions undergo surgery, while elsewhere, patients are monitored and only treated if clear signs of cancer appear.
While bronchoscopy isn't offered to everyone at risk of lung cancer, the researchers say their findings could help to develop a simpler blood test to pick up the same molecular signals that are linked to early cancer development.
"If we can use this new understanding of cancer development to create new diagnostic tests, it may one day be invaluable in picking up cancer early, enabling people to access treatment much earlier in the disease process," said co-first author Dr Adam Pennycuick (UCL Division of Medicine).
The study could also help lead to new treatments. Some of the genes that are expressed differently in lesions that will become cancerous, have previously been identified as potential drivers of lung cancer.
"We are now continuing our research to further understand how these genes are driving cancer progression, and to see which ones could be targeted by new drug treatments," said co-first author Dr Vitor Teixeira (UCL Division of Medicine).
Residual Lung Lesions After Completion Of Chemotherapy For ... - Nature
Little is known about the outcome of patients with residual pulmonary lesions, following successful chemotherapy for GTN with lung metastases at diagnosis. Additionally, there is uncertainty regarding the management of these residual lesions with some advocating surgical removal (Ilancheran, 1998). However, the work presented here shows that residual lung abnormalities in women who are in marker remission following chemotherapy for malignant GTN do not appear to have an increased risk of relapse. Consequently, we believe that these lesions simply represent dead tissue. Nevertheless, the absolute number of relapses in our study was small, so we cannot exclude the possibility that there may be a slight increased risk of relapse in patients with residual lung lesions when a larger cohort of patients has been studied. So is there any other data in the literature that might confirm or refute our findings?
There have been several smaller studies investigating the role of surgical resection for lung metastasis in GTN (Tomoda et al, 1980; Saitoh et al, 1983; Xu et al, 1985; Jones et al, 1993). However, unlike our study, all these have focused on surgery in patients with an elevated hCG associated with chemoresistant tumours and many were carried out before the introduction of curative combination chemotherapy for high-risk disease. The most recent of these studies was published in 1993 (Jones et al, 1993). Seven patients had surgical resection after chemotherapy; none had a normal serum hCG at the time of surgery. Additionally, five of the patients had extra pulmonary metastasis known to be associated with a poor prognosis. Indeed, three of these patients died of extrapulmonary disease. Interestingly, two patients with isolated pulmonary metastasis were cured by surgery as others have previously reported (Sink et al, 1981). Thus, a thoracotomy in the presence of a raised hCG is only likely to be helpful for isolated chemoresistant lesions and not when there is widespread disease (Sink et al, 1981). However, none of these studies really provides any additional data to that presented here concerning the management of residual lesions when the patients are in biochemical complete remission with a normal hCG.
In our study, not all the patients had the same radiological investigation at the end of treatment. Indeed, a higher proportion of patients with radiological abnormality at the end of treatment had CT scans. This is perhaps not surprising, as CT scanning is more sensitive at identifying lung lesions than CXR. Nevertheless, our results suggest that the observation of persistent radiological abnormalities at the end of the treatment has no bearing on the outcome for these patients. Therefore, the type of radiological test performed may be irrelevant. In view of the radiation exposure related to CT scanning, we do not recommend this investigation at the end of the treatment in this young patient population. Moreover, since radiological residual abnormalities in the chest do not appear to predict subsequent disease course, and relapses can be easily serologically detected by a rising hCG, one might be tempted to advocate no chest imaging at this time. Nevertheless, we still recommend performing a follow-up CXR on completion of therapy for women with lung metastases at presentation. This is because such imaging provides a useful baseline for future comparison. For example, should the patient undergo chest imaging for other reasons years later, the finding of a lung lesion might not necessarily prompt additional investigation if comparison with the previous films postchemotherapy shows no change. In addition, should the patient relapse and a CXR demonstrate a lung lesion, it would be important to know whether this was new, enlarged from before, or old and unchanged.
Perhaps unsurprisingly, this study also shows that patients with residual disease at the end of treatment have larger lung metastasis at diagnosis (Table 2). It may be that larger pulmonary metastasis result in more nonviable tissue after the completion of treatment.
In summary, chemotherapy alone cures the majority of patients with isolated lung metastasis. Radiological abnormalities at the end of treatment are of no prognostic significance if the patient is in hCG remission, and excision of these lesions does not therefore seem reasonable.
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