# Balancing Early Detection and Biopsy Risks in Sub-centimeter Lung Nodules: A Case Series

## TL;DR

This case series shows that small lung nodules can grow and become aggressive cancers, suggesting earlier biopsy may improve outcomes.

## Contribution

The study presents real-world cases where early biopsy of small lung nodules could have improved cancer detection and treatment timing.

## Key findings

- Three patients with small lung nodules later diagnosed with aggressive lung cancer showed significant nodule growth.
- Delayed biopsy may miss opportunities for early treatment in patients with growing nodules.
- Advanced bronchoscopy allows safe biopsy of small, hard-to-reach lung nodules.

## Abstract

Pulmonary nodules smaller than 8 mm are often monitored over time. In some patients, these nodules may grow while under observation, occasionally representing aggressive disease. We describe three patients with initially small pulmonary nodules that demonstrated significant growth during follow-up. Two were ultimately found to have small-cell lung carcinoma, and one had probable non-small cell carcinoma. These cases highlight the potential limitations of delayed tissue sampling and suggest that earlier diagnostic evaluation may be beneficial in certain patients. Advanced bronchoscopic techniques can allow safe and accurate biopsy of small, peripheral nodules. Earlier intervention in patients with growing nodules could support timely treatment and improve outcomes.