Pediatric lung ground glass nodules: a real-world, large-scale CT cohort analysis

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 < 3 mm or > 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 < 0.01). Children aged > 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.