Pulmonary Nodules and Lung Lesions

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The thoracic surgeons and interventional pulmonologists at UT Southwestern Medical Center use leading-edge methods to evaluate and treat pulmonary nodules and other various lung lesions – including bronchoscopic procedures, image-guided sampling, conventional surgery, and more advanced minimally invasive and robotic techniques.

We feature the latest imaging techniques and treatments through advanced imaging, including endobronchial ultrasound (EBUS), robotic bronchoscopy, and many others.

What Are Pulmonary Nodules and Lung Lesions?

Pulmonary nodules and lung lesions are spots or growths on the lungs.

Lung nodules can be benign (noncancerous) or malignant (cancerous). Lung nodules rarely have symptoms and are often incidentally found. They can represent an early opportunity to identify and treat lung cancer.

The most common causes of benign nodules include granulomas (clumps of inflamed tissue) and hamartomas (benign lung tumors).

The most common cause of cancerous or malignant lung nodules includes lung cancer or cancer from other regions of the body that has spread to the lungs (metastatic cancer).

Up to half of those diagnosed with early-stage lung cancer are identified through an incidentally detected lung nodule. However, not all incidental lung nodules are cancerous.

Why Choose UT Southwestern for Pulmonary Nodules and Lung Lesions?

Where patients go first for diagnosis and treatment truly matters. Our surgeons work closely with UT Southwestern’s interventional pulmonary team, oncologists, radiologists, and pathologists to deliver comprehensive care – all in one location.

From the time of first referral, patients can expect to see a provider within a week. The lung nodule clinic at UT Southwestern streamlines and expedites care to identify the correct treatment for patients.

What Are the Risks Factors for Pulmonary Nodules and Lung Lesions Being Cancerous?

The risk of a lung nodule being cancerous varies considerably depending on several things, including:

Age: Cancerous lung modules are rare in people younger than 35. Lung nodules have a 50% chance of being malignant and categorized as high risk in people who are over age 50.
Calcification: Lung nodules that are calcified are typically benign.
Cavitation: Nodules described as “cavitary,” meaning that the interior part of the nodule appears to contain air on X-rays, could be benign or malignant.
Growth: Cancerous lung nodules tend to grow fairly rapidly with an average doubling time of about four months, while benign nodules often remain the same size over time.
Medical history: Having a history of cancer increases the chance that a nodule could be malignant.
Occupation: Some occupational exposures raise the likelihood that a nodule is cancerous.
Smoking: Current and former smokers are more likely to have cancerous lung nodules than people who were never smokers.
Shape: Smooth, round nodules are more likely to be benign, while irregular or “spiculated” nodules are more likely to be cancerous.
Size: Larger nodules are more likely to be cancerous than smaller ones.

How Are Pulmonary Nodules and Lung Lesions Diagnosed?

If we suspect a patient has a pulmonary nodule, we will conduct a physical examination and order tests to confirm the diagnosis. Studies to evaluate and diagnose pulmonary nodules might include:

Bronchoscopy, including advanced guided techniques such as endobronchial ultrasound (EBUS), robotic bronchoscopy, and other procedures
Chest X-rays (radiographs)
Computed tomography (CT), including screening CT scan
Fluoroscopy, real-time X-ray imaging
Image-guided sampling techniques that include CT-guided and ultrasound-guided biopsies (fine needle aspiration biopsy or FNA)
Magnetic resonance imaging (MRI)
Minimally invasive lung biopsy (thoracoscopic or robotic)
Positron-emission tomography (PET)

Based on the characteristics and size of the lung nodule on the CT scan, we may recommend:

Observation and repeat X-ray studies if the nodule is likely benign
Further imaging, such as a repeat CT scan of the chest or a PET scan
Biopsy of the nodule via robotic bronchoscopy (if the nodule is near one of the airways), a needle biopsy (if the nodule is located near the outside of the lungs), or lung surgery (robotic thoracoscopic surgery) if we think it may be malignant

How Are Pulmonary Nodules and Lung Lesions Treated?

When surgery is the most appropriate therapy, our thoracic surgeons treat pulmonary nodules and lung lesions with procedures that include:

Lobectomy: Removal of an entire lobe by minimally invasive video-assisted thoracic surgery (VATS) or by robotic techniques
Segmentectomy: Removal of a segment of a lobe by minimally invasive VATS or by robotic techniques
Wedge resection: Removal of the lung nodule along with a small amount of lung tissue

Minimally Invasive Surgery

Compared with surgery performed through an open chest incision, minimally invasive surgery provides several important benefits for patients, including:

Faster recovery and return to normal activities
Shorter hospital stay
Less pain
Little scarring
Minimal blood loss
No cutting of the ribs or sternum

When surgery is not possible in a patient with a cancerous or malignant nodule, our multidisciplinary team of surgeons and medical and radiation oncologists will provide recommendations about the best management options, which may include advanced radiation techniques, systemic therapy with conventional chemotherapy, and/or targeted or personalized therapies.

What Clinical Trials Are Available for Pulmonary Nodules and Lung Lesions?

UT Southwestern conducts clinical trials aimed at improving the treatment of pulmonary nodules. Talk with our doctors to see if a clinical trial may be available.