Lung nodules or "spots on the lung" are common but abnormal findings on a chest x-ray or more commonly a CAT scan of the chest. The overwhelming majority of the time, these findings reflect inflammation or infection that is currently present or resolving Remember, that the lungs are exposed are exposed to millions of bacteria, virus particles, and fungal spores with each breath we take! However, in a minority of patients, especially those with risk factors, they can represent a pre-cancerous process or cancer itself. It is generally believed by the medical community that the majority but not all lung cancers do start as small nodules that grow and progress sequentially until the cancer becomes advanced. Therefore, lung nodules should be studied, characterized, and managed by a medical professional who is thoroughly familiar with them, up to date on their management, and
very comfortable with them.
A medical professional who is well versed in the management of lung nodules aims to simultaneously accomplish two goals for patients. One, he or she can spot lesions likely to represent a malignancy quickly and initiate management that is likely to diagnose cancer in an early stage that is highly treatable -and curable -with hopefully, minimal morbidity to the patient. Two, he can also often spot lesions that are very unlikely to represent malignancy and hence protect patients from the morbidity of unnecessary biopsies and the financial and mental burden of repeat CAT scans that ultimately prove unnecessary. However, it must be said that for some benign lesions, it is not always possible to avoid a biopsy -that ultimately shows a
non-malignant process. That’s OK too. The strong focus on never missing a malignant lesion really does take priority over the desire to avoid biopsies that ultimately are negative -but the two goals mentioned here are often simultaneously attainable.
When lung nodules are discovered, Dr Sternberg is often called on to assist with the management and decision making. Sometimes a repeat CAT scan is necessary. This is often done with lesions that are typically quite small and unlikely to represent cancer. If no growth is seen after a period of time, additional follow-up is often completely unnecessary. Sometimes a PET scan is ordered. This test further studies the lesion to see if its metabolism is higher than the normal lung tissue surrounding it. A higher metabolism than surrounding lung tissue can often reveal a malignant process, even when one is not strongly suspected based on the CT scan.
When a biopsy of a nodule becomes necessary, Dr Sternberg often performs Superdimension magnetic navigational bronchoscopy to biopsy the lung nodule -without any incision or hospital stay. This specialized technique makes use of magnetic fields and high resolution 3-D CT scans to guide biopsy needles directly to the nodule. This procedure has many advantages over the traditional core needle biopsy, the most important of which include a lower risk of lung collapse, more tissue acquisition, and a good internal look at the lung anatomy which can also often be of significant benefit. The patient goes home the same day, and after the biopsy or pathology report becomes available a few days later, Dr Sternberg meets with the family and counsels them about what type of future therapy if any, is needed.