My brother has a pe and a mass on lung with thyroid nodules. never smoked. he is hospital 5 days inr still 1.1. cat scan says possiable cancer. how will we know for sure ?

Biopsy when stable: The current studies suggest that there may be a cancer. The source could be the lung or thyroid. This could also be benign, but with the pe it will need further workup. After the pe is stabilized a biopsy is the only way to know.

Biopsy: Biopsy is needed to prove cancer. However, it cannot be done while on anticoagulation which he needs for the pe. You may consider a pet scan to find the easiest place to biopsy once the anticoagulation can be safely held. There are also alternative diagnoses to explain all of these findings, such as autoimmune diseases and infection. That said, you still need to rule out cancer.

Biopsy: The easiest in this case is to biopsy the thyroid nodules. You don't need to go off the anticoagulant to biopsy a thyroid nodule. The needles that we use is so small that bleeding is not a big concern with thyroid biopsies.