Lung nodules are small (under 3cm) lung spots, usually benign, often found incidentally on imaging, and typically caused by prior infection or inflammation. While rarely cancerous, most are asymptomatic, though large ones may cause coughing or shortness of breath. Diagnosis of lung nodules involves imaging (X-ray, CT), and management includes watchful waiting, biopsy, or treatment based on the nodule’s characteristics and the patient’s risk profile. Most lung nodules are non-malignant and can be left alone.
Discovering a lung nodule on a chest X-ray or CT scan is concerning, but understanding these growths and the available treatment options provides reassurance. As lung specialists, Neumark Lung & Chest Surgical Centre guides patients through the whole process from diagnosis to management of lung nodules.
A pulmonary nodule or a lung nodule is a small, typically benign, round or oval tissue growth seen on imaging. Having several small white spots on the lungs (nodules) can indicate prior infection or irritation. Common in people over 50, most are less than 3cm in diameter, and about 95% are non-cancerous. A lung nodule is often detected incidentally during unrelated imaging, facilitating early monitoring.
Understanding the specific terminology in your radiology report describing your pulmonary nodule can help you grasp your diagnosis.
Your report may distinguish whether a nodule is calcified or non-calcified.
Calcified nodules appear bright on CT scans and are often the result of a previous infection, such as tuberculosis or a fungal infection, that has healed. Certain patterns of calcification, like a completely calcified nodule or one with calcification in the centre, are reassuring signs that the nodule is almost certainly benign. Non-calcified nodules do not contain these calcium deposits. Most soft, non-bony lumps are harmless but should be evaluated by a physician.
Lung cancer is Singapore’s third most common cancer. Early detection and removal are critical for survival, so doctors treat every small lung spot as a potential cancer to ensure optimal patient outcome and ease worry about your lung nodule.
This approach, whilst it might seem overly cautious, has proven to be life-saving for many patients. Early screening for potentially cancerous nodules improves patient outcomes through timely treatment.
Most lung nodules are asymptomatic and found incidentally. Possible symptoms of lung nodules include chest pain, shortness of breath, coughing up blood, fatigue, fever, unexplained weight loss, or wheezing. Symptoms alone do not confirm cancer or guarantee a benign nodule; professional evaluation is necessary.
Sometimes, if a small lump is near a breathing tube, it can compress or partially block it. This can cause respiratory difficulties or recurrent infections. If you have breathing problems that don’t go away, tell your physician.
When to seek urgent care: If you experience coughing up blood, sudden, severe breathlessness, or acute, rapidly worsening chest pain, seek medical attention promptly.
It is normal to ask, “What size of lung nodule is worrisome?” because lung nodule size is a key indicator of malignancy risk.
| Size | Risk Factor |
| < 6 mm: | Very low risk (typically < 1%) |
| 6-8 mm | Slightly higher risk (around 0.5% to 2%) |
| 8-20 mm | Significantly increased risk (5% to 15%, depending on other factors) |
| > 20 mm (2 cm) | Highly concerning; cancer rates can exceed 50% in high-risk individuals |
| > 3 cm | Classified as a lung mass, usually requiring immediate investigation |
However, size is not the only factor. Nodule shape, density, border regularity, and temporal changes are crucial. Patient risk factors like age, smoking history and family cancer history also influence how worrisome a nodule of any size may be.
The Neumark Lung Screening Programme uses a quick, 10-minute low-dose CT scan (a special, low-radiation X-ray) to detect small nodules. This scan is better than a regular chest X-ray and can find spots as tiny as 2-3mm.
Finding these lung spots is common when people undergo low-dose CT scans or even regular X-rays for other respiratory problems. A multidisciplinary care team reviews all results to assess the nodule’s size, shape, consistency, and location, thereby informing treatment and management options.
Once your scan results are available, you will meet with our pulmonologist. They will review the results with you and answer any questions. In this meeting, they will present the findings, discuss any personal risk factors you may have, and recommend the most appropriate approach for monitoring or treating the nodule.
After your CT scan, the following steps help determine the best course of action:
Stable solid lung nodules that have not grown for approximately 2 years have a significantly reduced cancer risk, often eliminating the need for further imaging. Ground-glass and part-solid nodules, however, may require longer monitoring due to their slow rate of change. Follow-up uses low-dose CT to minimise radiation while tracking changes.
If the first scan shows a spot in the lung, doctors usually obtain a small tissue sample via a lung biopsy to examine it under a microscope. This is the most definitive method for determining whether the nodule is benign or malignant.
A lung biopsy might be advised for pulmonary nodules if they:
Very small nodules are usually monitored. A biopsy is typically considered only if the nodule grows or changes, as it can be hard to sample them safely and accurately.
The optimal tissue sampling method depends on the nodule’s location and characteristics.
Your pulmonologist will discuss the most appropriate approach, including its benefits and potential risks.
If you get a diagnosis of a lung nodule, you’ll need to see a thoracic surgeon. The next treatment depends on factors such as the nodule’s size, location, appearance, and the patient’s overall health.
Not all lung nodules need surgery. Non-surgical options may be suitable depending on the diagnosis. Here are some options:
Neumark’s surgical approaches represent the state of the art in the removal of lung nodules. Our minimally invasive options provide excellent outcomes with less discomfort and quicker recovery. Wedge resection is an operation in which a small, wedge-shaped piece of the lung containing the abnormal lump is removed. To do this, we perform either:
| Robotic Thoracic Surgery | Uniportal Video-Assisted Thoracoscopic Surgery |
| Our skilled surgeons use the da Vinci Robotic Thoracic Surgery (RATS) system for chest operations. This advanced robot provides the surgeon with better views and greater control, enabling them to remove lung nodules with greater accuracy while preserving as much healthy lung tissue as possible. | Uniportal Video-Assisted Thoracic Surgery (U-VATS) is a technique for removing lung nodules through a single small incision. This means less pain, less scarring, and a quick return to normal life, all while successfully removing the problem area. |
Confirmed lung nodules are often early-stage. Next steps include staging scans (e.g., PET and brain imaging) to assess for spread. A multidisciplinary care team of surgeons, oncologists and radiologists will develop a personalised treatment plan. For patients unfit for surgery, highly focused stereotactic body radiation therapy (SBRT) may be an effective alternative.
Treating lung nodules that are cancerous requires a comprehensive, personalised approach. The extent depends on the nodule’s size, location, stage, and the patient’s health. Early-stage lung cancers may only require limited resections like wedge resection or segmentectomy to spare healthy lung tissue. Treatment options include minimally invasive surgery, advanced clinical therapies, and, for more advanced cases, a lobectomy. We also partner with medical oncologists for necessary chemotherapy or radiation therapy.
The rate of recovery depends on the type of surgery. If you had a less invasive surgery, you can return to your regular activities in about 2 to 4 weeks, but it may take several months to fully heal internally. We provide comprehensive care after your operation, including managing your pain, guiding you through breathing exercises, gradually increasing your physical activity, arranging home care, and monitoring for complications. Ongoing surveillance is crucial for early detection of lung cancer recurrence.
At Neumark Lung & Chest Surgical Centre, our expert care team manages abnormal lung growths and a range of lung and chest conditions using advanced techniques. Our thoracic surgeons are highly trained in chest surgery and manage both benign and malignant conditions to provide optimal, effective care. Dr Harish Mithiran, Director and Senior Consultant Thoracic Surgeon at Gleneagles Hospital, offers patients expert, personalised care with groundbreaking minimally invasive treatments to improve outcomes. Please call us and schedule your appointment today.
CT scans detail nodule size, shape, density, and location to estimate cancer risk, but cannot definitively diagnose it. PET-CT may provide additional metabolic information, though it also has limitations.
Ground-glass opacity (GGO) on a CT scan appears hazy, allowing underlying lung markings to be seen, unlike solid nodules. GGOs often need careful long-term monitoring, as some may be slow-growing abnormalities.
Monitoring for stable solid nodules often stops after about 2 years. Ground-glass and part-solid nodules require longer follow-up, possibly several years, due to slow nodular changes. Your care team will tailor the schedule based on your risk factors and successive scan results.
A PET-CT scan is best for evaluating larger, uncertain nodules for cancer by detecting increased metabolic activity. However, it has limitations: inflammation can lead to false positives, and very small or slow-growing cancers can yield false negatives. A doctor will recommend a PET-CT scan when its utility is high for the specific case.
Lung nodule cancer risk correlates with size: under 6mm is very low (<1%); 6-8mm is 0.5-2%; 8-20mm is 5-15%; and over 20mm can exceed 50% in high-risk patients. However, a nodule’s appearance, growth, and personal risk factors are also crucial in determining the level of concern.
Pulmonary nodules are very common, found in up to 50% of adults undergoing chest CT scans, especially those over 50. The vast majority (around 95%) are benign. This high detection rate is due to the sensitivity of modern CT scanners, which can detect nodules as small as a few millimetres.
Lung nodules can shrink or disappear, often if caused by resolving infection or inflammation. Follow-up imaging is essential to observe this behaviour. A shrinking or resolving nodule is reassuring; however, further follow-up may still be warranted.
DISCLAIMER: The information provided on this website is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. The use of this website does not create a doctor-patient relationship and no medical advice should be inferred or assumed. It is the user’s sole responsibility to seek the advice of their healthcare professionals for any medical concerns they may have and the user should not disregard, or delay, prompt medical advice for any such condition.
Neumark Lung and Chest Surgery Centre benefits from the expertise of a multidisciplinary team led by Dr Harish Mithiran, senior consulting thoracic surgeon at Gleneagles Hospital and Mt Alvernia Hospital.
Neumark is a lung and chest specialist centre with access to leading treatment modalities to achieve the best possible outcomes for lung disease and preventative patient screening.
Our foremost priority is to treat your condition as effectively as possible. Schedule a private consultation today; complete the form below, call, +65 6908 2145; WhatsApp, +65 9726 2485; or email, info@neumarksurgery.com.
Gleneagles Medical Centre
6 Napier Road
#02-09 Gleneagles Medical Centre
Singapore 258499
Mount Alvernia Hospital
820 Thomson Road
#06-07 Medical Centre A
Singapore 574623