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Background <p>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.</p> Methods <p>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 &lt; 3&#xa0;mm or &gt; 30&#xa0;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.</p> Results <p>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 (<i>P</i> &lt; 0.01). Children aged &gt; 12 years had GGNs with larger volume and lower attenuation compared to younger children (<i>P</i> &lt; 0.05). Among the follow-up subgroup (<i>n</i> = 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 (<i>P</i> &lt; 0.05).</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月7日

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  • Ya-ni Duan,
  • Yue-fei Guo,
  • Jun-zhe Wen,
  • Xue Lin,
  • Yan-qiu Zhu,
  • Jie Qin

摘要

Background

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.

Methods

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.

Results

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).

Conclusions

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.