The present international system for staging lung cancer classifies multiple pulmonary nodules present in one pulmonary lobe or in distinct ipsilateral or controlateral pulmonary lobes as stage IIIB and IV, respectively. In our opinion this approach does not guarantee the patient the best choice of therapy. Moreover, some studies support the choice of surgery for patients with multiple pulmonary nodules without mediastinal lymph node involvement. Introducing PET may be of considerable help in making an informed choice. In this work we propose a diagnostic/therapeutic decisional algorithm for patients with multiple pulmonary nodules.