In view of the increasing number of “small nodules” found in clinical practice, which brings immense psychological pressure and economic burden to patients and families, I am going to tell you 3 short stories about what to do next if we find small nodules. Story 1: A female patient, 46 years old, a company leader, was found to have a lung nodule on physical examination. When she came to my clinic, she kept crying. I looked at the location and shape of the nodule and it was not typical lung cancer, so I marked it down and told her to go back for anti-inflammation and come back in 1 month with a film. The patient and her family were very excited, but they also thought that they should live their lives well, as they had been working hard for their careers for most of their lives, but had been neglecting their family and friendships. Story 2: Female patient, 58 years old, retired teacher, lung nodules were found on physical examination. The nodule was 1.5cm in size and irregular in shape. I also asked her to be anti-inflammatory for 1 month, and when I reviewed the CT, the report showed no significant change in the nodule, but I still felt that the nodule seemed to have become solid inside. So I suggested that she should undergo surgery directly. The surgery was performed using a minimally invasive approach and the patient did not feel any pain before and after the treatment. The postoperative pathology was adenocarcinoma, stage IA, so to speak, very early. I told the patient that for her, there was no need for any chemotherapy or radiotherapy, and the chance of cure was over 85%, but she still needed regular review. At first, the patient thought I was lying to her, thinking that there was no cure for cancer, but during the review process, she saw many patients who came back to see me 10 years after surgery, and she believed me at once, and finally a long-lost smile appeared on her face. Story 3: Male patient, 78 years old, retired worker. A lung nodule was found by chance on a radiograph because of a cough. The nodule was more than 2cm in size on the film, but the edges were still smooth. He was asked to observe the nodule for 3 months, and the nodule did not change on further films. The old man had coronary heart disease and atrial fibrillation, and the location of the tumor was very central, so the surgical resection biopsy could only be performed on the upper lobe of the left lung, not locally. So I suggested the old man to undergo CT-guided puncture, and finally the pathology confirmed that it was a tuberculosis granuloma. The old man’s son breathed a sigh of relief and now brings him to see me regularly. Friends, what do you learn from these three stories? Although the patients’ cases are different and the outcomes are not the same, can we not get the most important point from them? That is, for nodules of unknown nature, regular follow-up is stronger than all tests and treatments! NCCN guidelines recommend that nodules over 8 mm (or non-solid nodules over 1 cm) should be followed up regularly, generally requiring every 3 months at the very beginning. The reason for this arrangement is mainly from the biological behavior of tumors. The growth of tumor has a multiplication time, which is generally considered to be 2 months to 12 months, that is, the tumor can double in size in 2 months at the earliest, so for a nodule of 8mm, doubling in size is still relatively early, and it is difficult to have rapid dissemination and metastasis, so why do we need to take a big risk to do surgery? There was even a patient whom we followed up together for 6 years, and in the 6th year I saw that the nodule seemed to have changed a little, so I stopped the annual follow-up and operated on her, but in the end it was still a wall-like adenocarcinoma (originally called “fine bronchoalveolar carcinoma”), which is a type of tumor with a very good prognosis. This is a type of tumor with very good prognosis, extremely slow growth rate and almost 100% survival rate after resection. Some readers may ask, “Wouldn’t it be better to cut it out earlier? Unlike appendectomy or hernia repair, thoracic surgery is often associated with a high risk, which is not high but can sometimes be fatal. Suppose the patient is diagnosed with lung cancer, we can take the risk and try, but what if the final cut is benign and a comorbidity happens to cause the patient to have an accident? That would be unacceptable to the family and even more unacceptable to the doctor. Therefore, unless we are fairly sure that the nodule is malignant, we try not to opt for direct surgery, which is a consistent practice in our department and one that is accepted worldwide. It is worth mentioning that it is best to follow up at the same hospital so that the scans from the same machine are more accurate for comparison, and to follow the doctor’s orders. At first it is recommended to review every 3 months, and then if there is no change and it tends to be benign, you can gradually enlarge the review interval, eventually to once a year as a routine physical examination. Then some patients may ask, “Can we know whether it is a tumor or not by doing PET-CT? The answer is no, PET-CT is still not a substitute for regular review, it can only be a reference, but not a means to confirm the diagnosis. If you or a family member has a nodule in the lung, please feel free to come to my website or clinic for a consultation and I will work with you on the next step of the “battle plan”.