BACKGROUND: Pure ground-glass nodules (pGGNs) present management challenges due to their unpredictable growth patterns. This study aimed to assess the clinical and radiological factors associated with the growth of pGGNs within a 3-year follow-up period, and to provide a basis for individualized clinical management strategies. METHODS: A retrospective analysis of 93 patients with 138 pGGNs who underwent computed tomography (CT) follow-up examinations for more than 3 years was conducted. The patients were divided into the growth and stable groups, and the relationship between their clinical data and CT findings, and the growth of the pGGNs in the 3-year follow-up period was analyzed. RESULTS: Of the 138 pGGNs, 25 showed growth and 113 remained stable over the 3-year follow-up period. In the patient-based analysis, the frequency of pGGN growth within 3 years was 23.7% (22/93). In the nodule-based analysis, the growth frequency was 18.1% (25/138). In the multivariate analysis, an initial diameter ≥8.5 mm [odds ratio (OR): 78.367, 95% confidence interval (CI): 14.431-425.557, P<
0.002] and an irregular pGGN shape (OR: 12.719, 95% CI: 1.731-93.449, P=0.012) were identified as independent risk factors for growth within 3 years. CONCLUSIONS: When pGGNs have a maximum diameter ≥8.5 mm and an irregular shape, active surgical intervention may be a more appropriate clinical management approach than continued follow-up observation.