Management of the pulmonary nodule—shifting paradigms and an opportunity for change

The diagnosis of the pulmonary nodule, has metaphorically, been a diagnostic “Holy Grail” since the advent chest roentgenography over 100 years ago. We know where the pulmonary nodule is but until it is fixed in formalin, stained and placed under a microscope, we do not know what it is much like the proverbial Holy Grail. Although the vast majority of pulmonary nodules are benign, the early and accurate diagnosis of a malignant pulmonary nodule is of profound importance and the science of diagnosing pulmonary nodules has undergone an ever-changing evolution which can be divided into several eras.