The NCCN (National Comprehensive Cancer Network) and USPSTF (U.S preventive services task force) published evidence-based guidelines for the management of SPN in 2013. SPNs are classified as substantial nodules, ground glass opacity (GGO), and mixed ground glass nodules (GGN): Substantial nodules: <=6 mm with annual CT review for 2 years, no change with no follow-up< p=""> Enlargement greater than 1/4 of original diameter, surgery 6-8 mm3,9,12 8mm3,9,12,24 months repeat CT, no change stop follow-up Enlargement more than 1/4 of original diameter, surgery >8mm PET-CT considered tumor i.e. surgery negative3,9,12,24 months repeat CT, no change stop follow-up GGO <5mm no treatment< p=""> 5-10mm3,12,24,36 months repeat CT, no change stop follow-up If the enlargement exceeds 1/4 of the original diameter, surgery >10mm surgical treatment GGN<5mm without treatment < p=""> >5mm surgical treatment By the way, let’s talk about evidence-based medicine, Chinese culture has always been superstitious about individuals, which is directly related to our 2000 years of feudal rule, and thus all kinds of masters in the medical field appear frequently. A good doctor of the people sees 50 outpatients at a time, three times a week, 600 patients a month, 7200 patients a year, and less than 500,000 patients in 50 years of hard work. The evidence-based medicine database is more representative with millions of cases and from all over the world. All the time when a master says to you: i. “I can tell from one look at the film that you must be benign (malignant)”, a more advanced master will even tell you if it is adenocarcinoma, or carcinoma in situ. Remember that imaging diagnosis can never replace qualitative pathological diagnosis with 60-70% accuracy (CT), and the best PET-CT has an average sensitivity of 87% and specificity of 83%. ii. “This must be early stage for you, the lymph nodes are not enlarged on the film”, remember that lymph node metastasis can be up to 20% in patients with clinical diagnosis of stage I found during surgery. iii. “You have several nodes on this lung, metastasis, inoperable”, remember that of the multiple substantial nodes, 60% the other one is benign and should be locally excised and intraoperative freezing to determine metastasis. So please strictly follow the evidence-based medicine based guidelines for the management of SPN, the masters are personal experience and the ones who can keep up with the times are the real masters.