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Extrathyroidal extension (ETE) is a key factor in preoperative LNM prediction. The criteria for ultrasound diagnosis of ETE remain controversial. The aim is to determine if the length of capsule disruption (LCD) on three-dimensional ultrasound (3D-US) can predict cervical LNM in PTC patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>\n                      A prospective cohort of 168 patients from Peking Union Medical College Hospital was examined by 3D-US. The LCD was measured using the omniview mode of 3D-US. Statistical analyses included Chi-square tests,\n                      <jats:italic>T<\/jats:italic>\n                      -tests, Mann\u2013Whitney tests, ROC curve analysis, and logistic regression analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 126 patients included, 71 had LNM. Younger age, male gender, larger malignant nodules, LCD, echogenic foci, and thyroid capsule invasion were significantly associated with LNM. LCD\u2009\u2265\u20090.42\u2009cm increases LNM risk by 4.097 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). A nomogram was constructed incorporating gender, age, maximum diameter of the largest malignant nodule (MDLM), and LCD to estimate the risk of LNM. The accuracy and AUC of the nomogram were 73.0% and 0.795 (0.718\u20130.873).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LCD on 3D-US is a significant predictor of cervical LNM in PTC patients. This study\u2019s nomogram, based on easily measurable parameters, can help in the preoperative assessment of LNM risk, potentially guiding surgical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Can the LCD measured by 3D-US predict cervical LNM in PTC<\/jats:italic>\n                      ?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>LCD\u2009\u2265\u20090.42\u2009cm on 3D-US increase LNM risk by 4.097-fold. The nomogram with LCD, gender, age, and nodule size shows good predictive ability (AUC\u2009=\u20090.795)<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>LCD is a promising predictor of LNM, an alternative to ultrasound thyroid capsule invasion evaluation. The nomogram enables risk-adapted surgery, reducing unnecessary dissection or missed metastases to improve patient outcomes<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12070-6","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T17:31:15Z","timestamp":1760722275000},"page":"2690-2699","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predicting cervical lymph node metastasis in papillary thyroid carcinoma using capsule disruption length measured by 3D-US"],"prefix":"10.1007","volume":"36","author":[{"given":"Ruyu","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxin","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingjian","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luying","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruina","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuehua","family":"Xi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3389-5018","authenticated-orcid":false,"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"12070_CR1","first-page":"209","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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Liu R-Y, Jiang Y-X, Zhao R-N et al (2023) Evaluation of ETE of papillary thyroid microcarcinoma with three-dimensional tomographic ultrasound imaging. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 45:361\u2013365.\n                      \n                      . 2. Liu et al [\n                      \n                      ]\n                      \n                      . 3. Liu R, Jiang Y, Zhao R-N et al (2022) Comparative study of malignant risk assessment of thyroid nodules between three-dimensional ultrasound and two-dimensional ultrasound. Chin J Med Ultrasound 4:317\u2013324.\n                      \n                      .","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}