I have had my first lung cancer screening CT scan. What next?
Following your first screening CT scan, you will undoubtedly be having some worry about the result.
Many centers try to give you the result before you leave the center. All make an effort to get the result to you as soon as possible.
Most screened individuals receive a negative test result. Using IELCAP criteria, 12% or fewer receive positive test results. This means that either no nodule is found or only a small nodule; less than 6 mm in average diameter has been detected.
In either case, no action is required on your part for the next 12-months when you will be scheduled for your next “annual-repeat” CT scan.
If a positive scan is reported, recommendations will differ depending upon the size and type of nodule.
A calcified nodule has almost zero risk of cancer.
The white density in this nodule represents calcium, typically from an old TB or fungus infection.
A CT scan should be done in 12 months.
A non-solid nodule of any size has almost no risk of invasion or spread during the following year.
This faint grey nodule has a “ground glass” appearance typical of a non-solid nodule.
A CT scan should be done in 12 months.
A part-solid nodule is of greater concern.
This nodule ia mainly “ground glass” in appearance, but has a white solid componenent.
The solid component might represent early invasive cancer. A follow up CT scan is indicated in 3 months.
A small solid nodule is probably benign, but may be a cancer. Size matters.
if the nodule is between 6-8 mm a follow up CT scan should be done in 3 months to determine if the nodule is growing in size.
The nodule in the prior CT scan has grown in size. It is most probably a lung cancer and should be biopsied.
If the nodule is 8mm or greater, a PET scan is typically ordered
If the PET scan is negative the nodule is probably not a cancer; a CT scan should be repeated in 3 months.
If the PET scan is positive, the nodule may be a cancer or an active infection.
A bright white spot at the top of the right lung represents a “hot” or metabolically active nodule due to either a cancer or an active site of inflammation e.g. due to tuberculosis.
A needle biopsy may be ordered as the next step.
If the nodule is 1.5 cm or larger, it is hazardous to delay for observation of growth. A needle biopsy is the next step.
