Increasing detection of pediatric ground-glass nodules (GGNs) presents a clinical dilemma lacking robust evidence and guidelines. We aimed to evaluate the short-term natural course of incidental pediatric GGNs through real-world observation. This retrospective, single-center, real-world study screened children (0–18 years) undergoing low-dose chest CT between January 1, 2010, and December 15, 2025. Patients with GGNs were included, excluding those with malignancy, immune dysfunction, specific infections, mean diameter 30 mm, artificial intelligence recognition failure, or poor image quality. Baseline characteristics, clinical presentation, and CT imaging features were collected and analyzed, with subgroup analyses performed. For patients with follow-up CT, nodule evolution was assessed. Among 14,106 children, 901 (6.4%) had GGNs. After exclusions, 602 patients were included, with a median age of 15 (14, 17) years, 58.6% were male. From these patients, 602 most suspicious GGNs were analyzed, comprising 43 (7.1%) mixed GGNs and 559 (92.9%) pure GGNs. Mixed GGNs showed significantly larger size and higher attenuation than pure GGNs (P 12 years had GGNs with larger volume and lower attenuation compared to younger children (P < 0.05). Among the follow-up subgroup (n = 78), with a median follow-up period of 268.5 days, 32 GGNs regressed, 45 remained stable, and only 1 increased in size (pathologically confirmed adenocarcinoma in situ). Smaller GGNs at baseline were more likely to regress (P < 0.05). GGNs are not uncommon in children on chest CT. In our cohort, most GGNs remained stable or regressed over short-term follow-up. These observations suggest a relatively indolent short-term natural course and may support a conservative management strategy for incidentally detected GGNs in children. Given the limited follow-up duration, these findings should be interpreted with caution. Further studies with longer follow-up durations and larger sample sizes are warranted to elucidate the long-term natural course of pediatric GGNs.
Duan et al. (Thu,) studied this question.