If the risk seems high enough that the nodule could represent cancer, the decision is then made to proceed with either a biopsy procedure or a PET-CT scan. The PET-CT scans can be considered a specialized CT scan that will light up areas of cancer. It doesn't confirm a diagnosis of cancer, but a positive PET-CT increases the probability that the nodule is cancer and usually leads to additional invasive biopsy procedures. Two primary invasive procedures include the CT guided biopsy and bronchoscopy procedures. CT guided biopsy is where radiologists will sample the nodule with a needle under real-time CT guidance. Bronchoscopy is where a pulmonologist will navigate through the lung airways and sample the lymph nodes of the chest cavity and use guidance instruments to sample the lung nodule itself. In some cases, both procedures may be necessary. What happens after a biopsy procedure? If the biopsy is negative, great, most likely nothing else needs to be done except serially monitoring with followup CT scans. If the biopsy, however is positive for lung cancer, then a full staging workup needs to be done to see the extent of cancer spread. This will include getting a PET-CT if not already done, likely getting a brain MRI and bronchoscopy with sampling of mediastinal or chest cavity lymph nodes.
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