The purpose of this study was to evaluate the correlation between histological invasiveness and the computed tomography (CT) value and size in pure ground-glass nodules (GGNs) to determine optimal "follow-up or resection" strategies. Between 2001 and 2014, 78 resected, pure GGNs were retrospectively evaluated. The maximum diameter and CT value of pure GGNs were measured using a computer graphics support system. All GGNs with a maximum diameter a parts per thousand currency sign10 mm and CT value a parts per thousand currency signa'600 Hounsfield units (HU) were considered to be noninvasive lesions, while 21 of 26 (81 %) with a maximum diameter >10 mm and CT value >-600 HU were considered to be invasive lesions. With respect to the correlation between each histological type and pure GGN with a maximum diameter a parts per thousand currency sign10 mm and CT value a parts per thousand currency signa'600 HU, the specificity was 90 % and the sensitivity and negative predictive value were both 100 % in atypical adenomatous hyperplasia (AAH), while the specificity was 58 % and the sensitivity and positive predictive value were 0 % in minimally invasive and invasive adenocarcinoma. Pure GGNs with a maximum diameter of a parts per thousand currency sign10 mm and CT value of a parts per thousand currency signa'600 HU are nearly always pre-invasive lesions; therefore, surgery should be carefully selected in such patients.