Surgical approach to the small detected lung nodule

Incidental small lung nodules are increasingly encountered due to the widespread application of thoracic computerized tomographic scanning and improvements in resolution. The evaluation of solitary nodules less than 2 cm is particularly challenging. Although management may include additional radiographic imaging or sampling biopsy, thoracoscopic (video-assisted thoracoscopic surgery [VATS]) excisional biopsy is often the best option. VATS wedge resection by itself may be therapeutic, or lobectomy can be undertaken during the same anesthesia, thereby providing diagnosis and therapy with one procedure. Even for patients who cannot undergo lobectomy, VATS wedge resection is preferred to ablation therapy for lung cancers. The characteristics of some lung cancers that are found as small incidental nodules may make them particularly well treated with sublobar resection, although this requires further study.