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Published on: December 19, 2020
Pediatric lung ground glass nodules: a real-world, large-scale CT cohort analysis
Ya-Ni Duan1, Yue-Fei Guo1, Jun-Zhe Wen1
1Department of Radiology, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Insights
Pediatric ground-glass nodules (GGNs) are common on chest CT scans. Most GGNs in children show a stable or regressing short-term course, suggesting a conservative approach may be suitable.
Area of Science:
- Pediatric Radiology
- Thoracic Imaging
- Pulmonology
Background:
- Increasing detection of pediatric ground-glass nodules (GGNs) on chest CT scans presents a diagnostic challenge due to limited evidence and guidelines.
- This study addresses the clinical dilemma by evaluating the short-term natural course of incidentally detected pediatric GGNs.
Purpose of the Study:
- To evaluate the short-term natural course of incidentally detected pediatric ground-glass nodules (GGNs) using real-world observational data.
- To provide insights that may inform management strategies for pediatric GGNs.
Main Methods:
- Retrospective, single-center study of children (0-18 years) who underwent low-dose chest CT.
- Inclusion criteria focused on GGNs, excluding malignancy, immune dysfunction, and specific infections; exclusion of nodules <3mm or >30mm.
- Analysis of baseline characteristics, CT features, and nodule evolution in a follow-up subgroup.
Main Results:
- Out of 14,106 children, 901 (6.4%) had GGNs; 602 were included in the analysis.
- Mixed GGNs were larger and had higher attenuation than pure GGNs (P<0.01).
- In the follow-up subgroup (n=78), 32 GGNs regressed, 45 remained stable, and only 1 increased in size over a median of 268.5 days.
Conclusions:
- GGNs are frequently detected in children on chest CT.
- Most pediatric GGNs exhibit a stable or regressing short-term natural course.
- Findings suggest a conservative management approach for incidental pediatric GGNs, though longer follow-up studies are needed.
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.
