Purpose of review: Since the introduction especially of multidetector computed tomography scanners, detection of peripheral pulmonary nodules as small as 2-3 mm is now a frequent event even in individuals without a significant smoking history. This preponderance of small indeterminate nodules has necessitated reconsideration of the natural history of malignant lung tumors, in particular peripheral adenocarcinomas, as well as current clinical and radiologic guidelines to aid in the management of these lesions.
Recent findings: New information within the radiologic, pathologic and surgical literature is currently redefining nodule characterization. Most important has been the growing awareness of the prevalence of 'so-called' sub-solid pulmonary nodules, with important implications for revising our understanding of the natural history of these lesions as it impacts guidelines for nodule management.
Summary: Reassessment of our approach to small pulmonary nodules, while controversial, is now requisite as newer insights into the computed tomography appearance and natural history of small adenocarcinomas of the lung become apparent. Recognition of suspicious morphology and accurate measurements of volume doubling time, in particular, should aid in the management of these lesions.