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The clinical landscape of pulmonary nodule evaluation is shifting rapidly.1 The number of patients referred for assessment continues to climb, driven not only by expanding lung cancer screening programmes but also by the widespread, often liberal, use of CT. Incidental nodules have become an almost unavoidable consequence of modern imaging—detected in scans ordered for pulmonary embolism, infection, trauma, cardiovascular assessment or preoperative evaluation. These nodules appear without symptoms, clinical context or a clear diagnostic pathway, yet decisions must still be made.