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Patients with ESCC had ultrasound-guided fine-needle aspiration biopsy (US-FNAB) for SCLNs, with contrast-enhanced CT performed within 2 weeks prior to US-FNAB. A CT and ultrasound radiologist jointly analyzed images to identify and mark biopsied SCLNs &lt; 10\u2009mm on CT, followed by two blinded radiologists who independently measured short-axis diameter (SAD), long-axis diameter (LAD), short diameter of multiplanar reconstruction (SD-MPR), long diameter of multiplanar reconstruction (LD-MPR) and the intra-class correlation coefficient (ICC) was analyzed. Center 1 included 220 SCLNs as the training set, and Centers 2\u2009+\u20093 included 75 SCLNs as the validation set. The optimal cutoff value was determined using receiver operating characteristic (ROC) curves.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In the training and validation sets, 31.8% (70\/220) and 32.0% (24\/75) of SCLNs were positive. ICC for SAD was excellent (ICC\u2009=\u20090.847). The area under the receiver operating characteristic curve of SAD was 0.832 in the training set, higher than others, with a cutoff value of &gt; 6\u2009mm, resulting in sensitivity, specificity, positive predictive value, negative predictive value, accuracy of 77.1%, 80.7%, 65.0%, 88.3%, 79.1%, respectively. In the validation set, these metrics were 87.5%, 74.5%, 61.8%, 92.7%, 81.0%, respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>SAD on CT can suspect metastasis of SCLN\u2009&lt;\u200910\u2009mm in ESCC patients, with a threshold size of &gt; 6\u2009mm.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical relevance statement<\/jats:title>\n            <jats:p>Determining the threshold size criterion on CT images may enhance the prediction of supraclavicular lymph node metastasis in esophageal squamous cell carcinoma patients, thereby benefiting diagnostic and therapeutic strategies.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:list list-type=\"bullet\">\n                <jats:list-item>\n                  <jats:p>Supraclavicular lymph nodes &lt; 10\u2009mm in esophageal carcinoma are indeterminate for malignancy.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Supraclavicular lymph nodes &gt; 6\u2009mm are highly suspicious for malignancy.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>The metastasis status of supraclavicular lymph nodes is critical for staging esophageal carcinoma.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1186\/s13244-025-01929-3","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T17:46:46Z","timestamp":1741196806000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Threshold size criterion to suspect malignant supraclavicular lymph node &lt; 10\u2009mm in esophageal cancer"],"prefix":"10.1186","volume":"16","author":[{"given":"Yue","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingsai","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiantian","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoqi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Funing","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renzhi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ihab R.","family":"Kamel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8751-9988","authenticated-orcid":false,"given":"Jinrong","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"1929_CR1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3322\/caac.21763","volume":"73","author":"RL Siegel","year":"2023","unstructured":"Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics, 2023. 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