An important issue in the treatment of malignant tumours is concerned with the completeness of the resection/or destruction destruction of cancer and precancerous lesions, without which no curative intent can be contemplated. In lung cancer, be it central or peripheral, the pre-cancerous lesions, usually at the margin of cancer itself, will have to be treated. Image-guided lung cancer surgery and/or therapy is a method in which intraoperative real-time and updated images are provided to the operator, to allow him to access not only the tumour but also provide him with the outline of pre-cancerous lesions. As such, image-guided surgery and therapy provide navigational tools and real insight to perform complete treatment of cancer. In this chapter, the various methods to identify small lesions within the wide field of the lung tissue are referred to and some of the methods which are currently under translational studies are explored.