In recent years, physicians, especially thoracic surgeons, share a common feeling that more and more cases of tiny lung nodules, some purely hairy glass-like nodules, some solid nodules, and some partially solid nodules, are being found clinically. Some are a single nodule and some are several. These nodules, which vary in size, reality and number, are not only troublesome for patients but also for doctors. Let’s face it, are lung nodules really that difficult to deal with? Actually, this is a philosophical question. Because it needs to be considered with a philosophical mind. The main problem posed by microscopic nodules in the lungs is that they bring confusion to the treatment because of their indeterminate benignity and malignancy. If not treated, there is a risk of delay; if treated, it may be excessive. Doctors are mostly concerned with specialized questions, which are no more than: What are the characteristics of such a nodule? Are there any burrs? Is there a solid component? Are there any indications for surgery? Is it better to have a large or small surgery? Should the lymph nodes be completely or partially cleared, etc.? The patient is concerned about the choice of treatment. Is it benign or malignant? Doctors are not sure whether to do it or not? If you do it, it may be benign and you will receive a knife for nothing, after all, it is also an open-heart surgery; if you don’t do it, in case it is malignant, it will be a problem if you delay it. It is these problems that make some patients and even family members sleepless and sleepless at night. Thinking back to the current situation of our clinical treatment, doctors’ opinions are also very inconsistent, resulting in some doctors advocating surgical investigation regardless of benign malignancy, so as to avoid future patient complaints; some doctors are overly cautious, afraid of misdiagnosis and afraid to make a diagnosis, allowing patients to do a CT every three months, and patients are in long-term anxiety and anxiety. There are also individual doctors who are overconfident, causing delays or unnecessary surgical trauma. Patients and friends must ask, how could this happen? One of the reasons is that microscopic nodules in the lung are difficult to diagnose due to the lack of imaging features. Tumor markers and other tests have little reference value, and the only definitive diagnosis, puncture biopsy, is also very difficult to hit the target. However, CT itself has its own advantages and disadvantages, such as the CT performance of the same patient in different hospitals can be very different, and even the CT taken by the same hospital with different parameters can be different. Second, the imaging performance of microscopic lung nodules is difficult to describe clearly, and comes more from the experience or feeling of the doctor. Clinicians must experience a considerable number of cases before they can make a more accurate decision. At present, the accuracy rate of the diagnosis of pulmonary nodules in our department is at least 80%, which is closely related to the large number of cases of pulmonary nodules treated in our hospital, as well as our strong diagnostic imaging team and the weekly intra-institutional joint examination, which are the favourable conditions and the joint efforts of all of us to be confident today. Third, although there are several expert consensus on pulmonary nodules (international, domestic, Beijing, Shanghai, etc.), it is difficult to operate them in practice. Some nodules are less than 0.8 cm in diameter but are already adenocarcinoma after excision; some nodules are already more than 2 cm in diameter but their biological behavior still tends to be benign; some nodules are considered purely gross glass by one expert and partially solid by another; the former can continue to be observed while the latter requires surgery; some nodules only require wedge resection, others require lung segmentation or anatomical partial lobectomy, and still others require Some nodules do not require systemic lymph node dissection, while others require full lymph node dissection. With so much uncertainty, it is difficult to reach consensus within the physician community. For the patient, the most important concern is to find out whether the node is benign or malignant. When the doctor cannot give a definite answer, there is inevitably a lot of psychological anxiety. I often encounter patients in the clinic who are overly worried about the nodules being malignant or malignant in the future, which seriously affects their normal life. In some cases, I can basically conclude that the nodule is benign, so I tell the patient that surgery is not needed and that the patient can be observed. However, the patient’s psychological burden could not be put down because he had already been told by a doctor to do surgery or it would metastasize. In addition, some patients have a family history of metastasis, so they are even more frightened. Therefore, how to treat the diagnosis and treatment of microscopic lung nodules rationally has turned from an academic level to a philosophical issue. For doctors, it is not only necessary to strictly comply with treatment norms, but also to individualize the diagnosis and treatment according to the patient. Currently, our department has conducted several studies on this topic, and it is expected that a standard or guideline will be developed in the near future. For the patient, it is important to be calm. There is no need to be nervous, let alone panic, when tiny nodules are found in the lungs. Even if they are malignant, the treatment results are very good. Once faced with a choice, it is important to analyze the situation thoroughly and to grasp the main issues. If a nodule is considered benign by your doctor, there is no need to rush into surgery, just follow it closely. It is better to have regular low-dose CT, which not only does not delay the diagnosis, but also reduces the radiation impact on the body caused by conventional CT. As for nodules with high suspicion of malignancy, it is better to operate as soon as possible. In addition, in recent years, more and more cases of multiple nodules in the lungs have been found. Our department has also formed a basic consensus on the management of such cases. In other words, the focus is on the lesion with the most solid components, and the entire lesion should be removed if possible. If bilateral lesions can be operated at once, it is best to operate at once, and those who cannot tolerate one operation should be treated on the side with less impact on lung function first. Although it is difficult to diagnose and treat pulmonary nodules, especially microscopic nodules, through the fog, we have developed a reliable means of diagnosis and treatment. We believe that with the further improvement of examination equipment and the accumulation of doctors’ experience, the management of such cases will become more and more mature and reasonable.