Background: The clinical burden of competent pulmonary nodule identification and definitive diagnosis is increasingly common. This is especially true in complex cases with conflicting results from diagnostic tests and procedures. Clinicians are tasked with in-depth difficult discussions with their patients when risk calculators, imaging, genetic and other adjuvant testing information points definitively either at benign or malignant process. Clinical presentations with unusual risk, imaging, age, functionality or newer adjuvant testing parameters make these discussions nearly impossible. I present three cases employing noninvasive sputum flow cytometry analysis in addition to standard LDCT, PET scans and blood proteomic testing to help address clinical decisions in three “atypical” presentations in our pulmonary nodule clinic.