{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T05:07:32Z","timestamp":1783832852871,"version":"3.55.0"},"reference-count":35,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the diagnostic value of a machine learning (ML) model based on multi\u2010modal ultrasound features in differentiating benign from malignant cervical lymph nodes, and to provide a visual interpretation of model decisions using shapley additive explanations (SHAP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 190 patients with suspected cervical lymph node lesions who obtained a pathological result at the Fourth Affiliated Hospital of Harbin Medical University between August 2022 and January 2025. All patients underwent 2D ultrasound, color Doppler flow imaging (CDFI), microvascular flow imaging (MVFI), and contrast\u2010enhanced ultrasound (CEUS). Clinical data (age and sex) and multi\u2010modal ultrasound features were collected. Univariate analysis was used to identify variables significantly associated with lymph node malignancy. Ten ML algorithms were developed and compared to construct predictive models. Model performance was evaluated using multiple metrics such as the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and F1 score. The SHAP framework was applied to interpret the decision\u2010making process of the optimal model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Univariate analysis identified 18 features significantly associated with malignancy, including age, short axis, L\/S ratio, morphology, cortical thickness, cortical echogenicity, calcification, cystic change, hyperechoic foci, reticular\/cord\u2010like echogenicity, hilum visibility, CDFI vascular pattern, pulsatility index (PI), MVFI vascular pattern, vascularity index (VI), CEUS enhancement pattern, enhancement uniformity, and necrotic regions. Among the 10 ML algorithms, the gradient boosting machine (GBM) model achieved the best diagnostic performance, with an AUC of 0.987 (95% CI: 0.967\u20131.000), accuracy of 0.929, sensitivity of 0.879, specificity of 0.965, and F1 score of 0.935 on the test set. The GBM model significantly outperformed an experienced ultrasound physician (AUC\u2009=\u20090.904,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.03). SHAP interpretation revealed that the most influential features for prediction included CEUS enhancement pattern, L\/S ratio, age, PI, and VI. The case\u2010based analysis further demonstrated that malignant lymph nodes were commonly associated with a combination of centripetal heterogeneous enhancement on CEUS, L\/S &lt;2, presence of hyperechoic foci, mixed\u2010type vascularity on MVFI, and elevated VI values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The GBM model based on multi\u2010modal ultrasound features enables accurate differentiation between benign and malignant cervical lymph nodes. SHAP provides a transparent, visual interpretation of model decisions, demonstrating a novel methodological framework that integrates multi\u2010modal data with explainable AI, supporting its potential as a reliable tool for clinical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jum.70223","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T08:29:50Z","timestamp":1772958590000},"page":"1715-1730","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differentiation of Benign and Malignant Cervical Lymph Nodes Using a Multi\u2010Modal Ultrasound\u2010Based Machine Learning Model With\n                    <scp>SHAP<\/scp>\n                    Interpretability"],"prefix":"10.1002","volume":"45","author":[{"given":"Mingru","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Ultrasound The Fourth Affiliated Hospital of Harbin Medical University  Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0857-2659","authenticated-orcid":false,"given":"Yuping","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The Fourth Affiliated Hospital of Harbin Medical University  Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Tian","sequence":"additional","affiliation":[{"name":"School of Intelligence Science and Technology Beijing University of Civil Engineering and Architecture  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The Fourth Affiliated Hospital of Harbin Medical University  Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of General Surgery The Fourth Affiliated Hospital of Harbin Medical University  Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haohao","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The Fourth Affiliated Hospital of Harbin Medical University  Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The Fourth Affiliated Hospital of Harbin Medical University  Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqiu","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Ultrasound The Fourth Affiliated Hospital of Harbin Medical University  Harbin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6985-3253","authenticated-orcid":false,"given":"Kuo","family":"Miao","sequence":"additional","affiliation":[{"name":"Department 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