SPN with family history of lung cancer -Diagnosed with a solitary pulmonary nodule in right upper lobe

Hi, There isn’t a well-characterized lung cancer family. This is because smoking confounds any estimates (there is no statistical test that can ensure removal of its effects). Of course, the situation changes if there are other cancers (aside from lung) affecting other close family members. On top of this problem, there isn’t a clearly effective screening strategy for lung cancer either. The 1/16 translates to about 1.6mm, the size doesn’t particularly raise suspicion. But if there are other features like irregularity, absence of calcification, irregularity of borders, may raise the possibility of cancer. The PET scan holds promise, but there are overlaps between the uptake signature of malignant and benign lesions. If you have a history of TB exposure, this may look the same as cancer on the PET. Hence, standardization may be a problem. At present, CT scan (particularly low dose) is being developed as a screening tool. There really isn’t a clear answer here. Since you’re done the PET, if the uptake is suspicious, you can elect to have subsequent PET scans to monitor or consider a biopsy (this is a tough decision to make, as finding it with a needle may be technically difficult so the biopsy becomes removing a larger chunk of lung). IF the PET has normal uptake – monitoring with a CT scan may be sufficient. Whichever way you decide, weigh the risks of the procedure. If you are not smoking yourself, there is no clear reason to label you as high-risk, so you may need to be more on the conservative side.

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