The development of lung cancer screening using CT has made it possible to explore small lung nodules. Limited surgical resection is gradually becoming the standard of care for small volume lung cancers that CT Henan Cancer Hospital, Department of Thoracic Surgery, Qin Jianjun shows to be gross glassy nodules (GGN). This is due to the main consideration that such lesions are rarely pathologically aggressive. However, there are some reports describing poor prognosis for sub-centimeter lung cancers, especially for those that present as solid on thin CT scans. Some results clearly show that if a tumor has an intrinsic component even if it is less than 1 cm it does not mean that the tumor will not spread. To clarify the relationship between the proper treatment strategy for small lesions and lymph node metastasis, Professor Kenji Suzuki et al. of the Soon Chun University School of Medicine in Japan conducted a retrospective analysis of 135 cases of sub-centimeter lung cancer and found that sub-centimeter lung cancer is still likely to have lymph node metastasis, especially in solid nodes with high SUVmax values. The article was published in the June 27 issue of EJCTS. Figure 1: Establishment of the study population, with purely gross glassy nodules (GGN) excluded from this study, resulting in 71 subcentimeter lung cancers with solid changes entering the statistical analysis. A total of 135 cases of subcentimeter stage c-N0 lung cancer from 2004-2011 were counted in the article. 71 cases showed solidity on thin-section CT scan. 49 patients underwent lymph node pathology and lymph node metastasis was found in 6 (12.2%) patients. All lung cancer lesions with lymph node metastases were purely solid (p=0.0010). In these patients with solid subcentimeter lung cancer, maximum standardized uptake value (SUVmax) was found to be the only significant predictor of lymph node involvement by multifactorial analysis. Regarding surgical outcome, the 5-year survival and disease-free survival rates were 100 and 97.8% for partial solid lesions, compared with 87.3% and 74.8% for solid lesions, respectively. Moreover, there was a significant difference in disease-free survival between the high SUVmax group (60.0%) and the low SUVmax group (94.9%) (p=0.0013). Figure 2: Postoperative survival curves for 45 subcentimeter lung cancers with partial solid lesions (c-N0) showing 5-year survival and disease-free survival rates of 100 and 97.8%, respectively. Figure 3: Postoperative survival curves for 26 sub-centimeter lung cancers with solid lesions (c-N0) showing 5-year survival and disease-free survival rates of 87.3 and 74.8%, respectively. Figure 4: Comparison of postoperative survival rates between the high SUVmax group (60.0%) and the low SUVmax group (94.9%) (p=0.0013). The above results suggest that lymph node metastasis may still occur in solid lesions even in sub-centimeter lung cancer, especially for lesions with high SUVmax values. Therefore, intraoperative lymph node evaluation should be adequately performed to prevent local recurrence in solid subcentimeter lung cancer undergoing limited surgical resection.