Objective To explore the factors related to the identification of benign or malignant pulmonary ground-glass nodule (GGN) through studying the clinical features of patients with lung GGN diagnosed by pathology. Methods The clinical data and imaging data from 181 patients, who were pathologically confirmed to have lung GGN in Changhai Hospital of Second Military Medical University from Oct. 2013 to Oct. 2016, were retrospectively analyzed. Statistical software SPSS 19.0 was used to conduct univariate analysis and multivariate logistic regression analysis of influencing factors of benign or malignant lung GGN. The coincidence of chest CT diagnosing benign or malignant lung GGN and the pathology diagnosis was analyzed with Kappa consistency test. Results Of the 181 patients, 106 had malignant lung GGN and 75 had benign lung GGN. Univariate analysis showed that age, smoking index, maximum diameter of GGN, spiculation, lobulation, pleural indentation, vacuole sign, air bronchogram sign and CT value were the influencing factors for the differential diagnosis of benign and malignant lung GGN (all P<0.05). Multivariate regression analysis showed that aged, spiculation, lobulation, pleural indentation, air bronchogram sign, vacuole sign and increased CT value were independent risk factors of malignant lung GGN (all P<0.05). Compared with benign lung GGN, chest CT had a higher accuracy in diagnosing the malignant lung GGN (80.3% vs 65.3%, χ²=5.698, Kappa=-0.122, P=0.017). For the benign GGN, inflammatory lesions were more likely to be misdiagnosed versus tuberculosis (χ²=22.626, Kappa=0.593, P<0.001). Conclusion For older patients with chest CT signs including lobulation, spiculation, pleural indentation, air bronchogram sign, vacuole sign and increased CT value, malignant lung GGN should be highly suspected. When diagnosing benign lung GGN, the doctors should comprehensively analyze patient general situation, clinical features and imaging findings of the patients.