Found 7mm bilobed peripheral nodule , what is bilobed ex heavy smoker .pulmonologist wants to do bronchoscopy with bal and biopsy could it be cancer ?

See below: I think a biopsy of a 7mm nodule would be very difficult to hit. Even using ENB and going right to the nodule, it would be difficult for a good sample at 7mm. Usually 1cm is the cut off for biopsy using guidance. I don't think it would be possible to biopsy something even 1cm without guidance unless you were just super lucky.

Fleischner Society: guidelines for a 7mm incidental nodule in a high risk patient suggest follow up CT at 6-12 months and then at 18-24 months if no change. Biopsy of a nodule this size technically difficult.