Solitary pulmonary nodule: time to think small

The challenge presented by a solitary pulmonary nodule has faced physicians and patients since the advent of the chest radiograph. Is the nodule malignant or benign? When should something be done about it and what should that be? The majority of solitary nodules are benign, but the detection of a nodule may be the first and only chance for cure in the patient with lung cancer. The expanding availability and use of computed tomography are leading to increased numbers and decreased size of nodules detected. Surgical resection remains the most sensitive and specific method of analysis but introduces morbidity and mortality that may be unnecessary and avoidable. Advances in radiographic techniques have improved the ability to noninvasively identify whether a nodule is likely malignant or benign. Application of these techniques may ease the decision making and reduce the incision making.