Lung cancer is the malignant tumor with the highest incidence and mortality rates worldwide, and its high lethality is primarily due to its subtle early symptoms, with most cases being diagnosed at an advanced stage. Currently, the diagnosis of lung cancer mainly relies on tissue biopsy to obtain pathological evidence, but this method has limitations such as high invasiveness, restricted sampling, and the risk of complications. Therefore, developing safe, effective, and non-invasive strategies for the early screening and diagnosis of lung cancer (stages Ⅰ/Ⅱ) holds significant clinical importance. As a key component of liquid biopsy, exosomes can stably carry a variety of biological molecular information from their cells of origin. Studies have shown that microRNAs, long non-coding RNAs, circular RNAs, and specific proteins abundantly present in exosomes exhibit abnormal expression during the development of lung cancer, demonstrating high diagnostic value. Compared to traditional detection methods, exosome-based detection offers advantages such as non-invasiveness, repeatability, ease of operation, and cost-effectiveness. This article systematically reviews recent research progress on exosomes as liquid biopsy biomarkers for the early diagnosis and screening of lung cancer, focusing on their potential clinical applications, and explores the prospects of exsomes in the early intervention, precise diagnosis, and prognosis improvement for lung cancer.