Management of the subcentimeter pulmonary nodule

The most sensitive imaging modality for detection of pulmonary nodules is computed tomography (CT). Advances in radiologic techniques not only increase the number of nodules detected, but also the nodules that are identified are smaller. With increased use of spiral CT for lung cancer screening, there will be more subcentimeter pulmonary nodules (SCPNs) that will require further diagnostic workup. Radiologic evaluation including repeat observational CT or CT contrast enhancement should be performed. Bronchoscopic or needle biopsy of the majority of SCPNs is not practical. VATS is possible for SCPNs but should be performed in a controlled manner to reduce the resection of benign lesions. An SCPN management algorithm is necessary to expedite resection of a malignant lesion and to minimize removal of benign disease.