Abstract: Early detection and accurate diagnosis for lung cancer is crucial to reduce disease-related mortality. Low-dose CT image is the main method of early lung cancer screening. This review introduces the importance of lung cancer screening and the feasibility of small biopsies of lung nodule in clinical practice, and focuses on how to obtain the sample from lung nodule efficiently with low cost and less side effect, and manage the specimen appropriately in order to achieve accurate diagnosis and following ancillary tests to guide clinical practice. We summarize the common pathological diagnosis and differential diagnosis in small biopsies, and the application of small lung biopsy in the pathological staging and molecular tests.