Lung CT Findings: What Do White Spots Mean?

Q: Lung CT Findings: What Do White Spots Mean?

Hello： Without a pathological biopsy report, it is impossible to determine whether the small nodule is benign or malignant. <br>If it is malignant, it indicates that metastasis has occurred, and the prognosis in three months is likely poor. <br>If it is benign, the small nodule m

Pulmonary CT scan ground-glass opacities?

Hello Doctor, I would like to inquire about my mother.
During her chest X-ray, there were no abnormalities, and she did not exhibit any symptoms (she has been hoarse recently, but fortunately, a laryngoscopy revealed vocal cord nodules).
Due to her smoking history, the doctor recommended a CT scan.
In the recent CT scan, round white spots were found adjacent to the pulmonary vessels, with three spots measuring 0.4 cm, 0.7 cm, and 1 cm.
The chest physician checked the cancer markers (as follows), and all results were normal! The oncologist suggested regular follow-up, but the chest physician indicated that surgery or a three-month follow-up would be necessary, making it difficult to decide.
I would like to ask if regular intensive follow-up is also a viable option? Will a three-month follow-up lead to sudden worsening? The cancer embryonic antigen test result is 0.954, CA-125 tumor marker (EIA/LIA method) is 15.560, CA-153 tumor marker (EIA/LIA method) is 4.190, CA-199 tumor marker (EIA/LIA method) is 9.470, SCC tumor marker (EIA/LIA method) is 0.600, and tumor-associated glycoprotein is 25.000.

Han, 20~29 year old female. Ask Date: 2019/11/11

Dr. Yang Wenda reply Pulmonology

Hello: Without a pathological biopsy report, it is impossible to determine whether the small nodule is benign or malignant.
If it is malignant, it indicates that metastasis has occurred, and the prognosis in three months is likely poor.
If it is benign, the small nodule may decrease in size after three months.
If you are concerned about potential adverse changes in three months, you may consider excising the 1 cm nodule or performing a biopsy.
Otherwise, you can follow the recommendation to monitor it again in three months.
Additionally, consider whether there is a family history of malignant tumors, as this would warrant a more proactive approach, such as obtaining a biopsy or surgical specimen for further evaluation.
This is for your reference!

Reply Date: 2019/11/11

More Info

When it comes to interpreting lung CT findings, particularly the presence of white spots or nodules, it's essential to approach the situation with a comprehensive understanding of the potential implications. In your case, the discovery of three round white spots adjacent to the pulmonary blood vessels, measuring 0.4 cm, 0.7 cm, and 1 cm, raises several considerations.

Firstly, it's important to note that lung nodules can be benign or malignant. The size, shape, and characteristics of these nodules, along with the patient's history (such as smoking), play a crucial role in determining the likelihood of malignancy. Given that your mother has a history of smoking, this factor increases the need for careful monitoring, as smoking is a significant risk factor for lung cancer.

The fact that the cancer markers (tumor markers) you mentioned, such as CEA, CA-125, CA-153, CA-199, and SCC, are within normal ranges is reassuring. These markers can provide additional context, but they are not definitive for diagnosing or ruling out cancer. Normal levels suggest that there may not be an active malignancy at this time, but they do not eliminate the possibility of cancer entirely.

Regarding the recommendation for follow-up, both the oncologist's suggestion for regular monitoring and the pulmonologist's consideration of surgical intervention reflect a cautious approach to managing these findings. Regular follow-up, typically every three months, is a standard practice for monitoring lung nodules, especially when they are of a size that warrants concern. The rationale behind this approach is to observe any changes in the size or characteristics of the nodules over time. If a nodule grows or changes in appearance, further diagnostic steps, including a biopsy or surgical intervention, may be warranted.

You asked whether more frequent monitoring could be beneficial and whether waiting for three months could lead to a worsening condition. In general, three-month intervals are common for initial follow-up of lung nodules. If there is a significant concern about the nodules based on their characteristics or if your mother develops new symptoms (such as persistent cough, weight loss, or hemoptysis), then more immediate evaluation may be necessary.
It is also worth considering that not all nodules will progress to cancer, and many can remain stable for years without any intervention. The decision to pursue surgery versus monitoring should be made collaboratively between your mother and her healthcare team, taking into account her overall health, the characteristics of the nodules, and her personal preferences.

In summary, regular follow-up is a prudent approach in this situation. It allows for careful monitoring of the nodules while minimizing unnecessary interventions. If there are any changes in symptoms or if the nodules exhibit growth, further evaluation can be conducted promptly. Open communication with her healthcare providers is essential to ensure that all concerns are addressed and that the best course of action is taken.

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