Chest X-ray showed a single nodule. Is a biopsy required to rule out cancer?

Question

Hello doctor,

I am a 30-year-old female. The initial illness began early this year. The symptoms were cough, shortness of breath (SOB), chest pain, and wheezing. I was treated for pneumonia but never got better. Repeated X-rays showed adenopathy as a possibility. So, a CT scan was done which showed hilar, mediastinal adenopathy and a single pulmonary nodule of 0.47 inch along with some hypodense lesions on the spleen. A biopsy was done on the lung tissue and on the endobronchial mass but not on the lymph nodes or nodule. There was no fungal, bacterial or viral cause isolated. I have been largely asymptomatic since then with an exception of some chest pain. I went in for a follow-up computed tomography (CT) scan last week. There is still hilar, mediastinal adenopathy and now pre-tracheal aortopulmonary adenopathy along with the nodule. But, the size is the same. The doctor wants a CT scan in four months and thinks this could be the result of a fungal infection but he is not sure. I am wondering if a biopsy of the actual nodes or nodule would be necessary to rule out cancer. I am so concerned and the thought of waiting four months is devastating. I am a former smoker for five years. I take Lexapro, Adderall, and Microgestin.

Answer 1

Hello,

Welcome to icliniq.com. I went through your history. There are two clinching things. One is apulmonary nodule and other is mediastinal adenopathy. 1. For pulmonary nodule of 1.2 cm, it can be due to a number of reasons. But, if it is not enlarging in size it is most probably benign. Just get a simple computed tomography (CT) guided FNAC (fine needle aspiration cytology) properly (incorrectly taken sample gives false results). 2. If FNAC is not showing anything, then surely it is not a lung mass. Then, you can consider a fungal infection and rather than trying to diagnose it, take a course of antifungal (not everything is ideal in medical science). 3. For hilar lymphadenopathy, you should to an EBUS (endobronchial ultrasound) and get an FNAC of the mediastinal adenopathy. It will surely tell us everything about cancer if any. 4. The probable diagnoses are sarcoidosis, fungal infection and a benign mass in the lung (at the age of 30, there is very less chance of malignancy).