Clinicians use three common strategies to manage lung nodules: serial CT scan follow-up, biopsy, and surgery. They select a management approach based on the nodule type, malignancy risk, patient-specific risk factors, and potential surgical risks.

CT scan follow-up

CT scan follow-up is the most common method to manage lung nodules. With serial chest CT follow-up, clinicians can monitor changes in lung nodules (e.g., size, density, or morphology). This approach typically works for nodules with very low or low malignancy risk. It may also suit patients who have contraindications to biopsy or surgical intervention.

Clinicians perform follow-up using high-resolution CT (HRCT). They determine the follow-up interval (whether shorter or longer) based on their assessment of the nodule’s risk.

Biopsy

Clinicians sometimes need a biopsy to achieve a definitive diagnosis of a lung nodule. As an invasive procedure, a biopsy carries potential risks—so clinicians recommend it mainly for nodules with moderate malignancy potential. It also helps in cases where clear preoperative evidence of malignancy is needed, especially when surgery poses significant risks to the patient.

In most cases, clinicians perform a lung nodule biopsy by obtaining a tissue sample from the nodule via percutaneous puncture, which confirms the nodule’s pathological nature. In rare cases, they may also use fiberoptic bronchoscopic lung biopsy to establish a diagnosis.

Surgical procedures

Surgery acts as both an important method to definitively diagnose and treat lung nodules. Clinicians recommend surgical intervention for nodules with high malignancy risk, unless the patient has contraindications or cannot tolerate surgery.

Common surgical approaches include minimally invasive surgery (MIS) and open thoracotomy. Video-assisted thoracoscopic surgery (VATS)—such as thoracoscopic resection (including wedge resection, segmental lung resection, and lobectomy)—is the most common method clinicians use to diagnose and treat lung nodules with high malignancy potential.

Other treatments

In addition to the above strategies, clinicians may use other treatments (e.g., radiotherapy and chemotherapy) when clinically indicated—for example, for confirmed malignant nodules with metastasis or unresectable disease.