{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T03:27:39Z","timestamp":1788406059055,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Medullary thyroid carcinoma (MTC) frequently presents with lateral lymph node metastasis (LLNM), a critical determinant of postoperative recurrence. While surgery remains the cornerstone of MTC treatment, the indications for lateral lymph node dissection (LLND) remain contentious. This study aimed to develop and validate a predictive nomogram for assessing LLNM risk in patients with MTC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed 87 treatment-na\u00efve MTC patients who underwent primary surgical resection at our institution. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LLNM. A nomogram was constructed and internally validated, with its clinical utility evaluated through discrimination, calibration, and decision curve analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Univariate analysis identified multifocality, intrathyroidal lymphovascular invasion (IT-LVI), extrathyroidal extension (ETE), central lymph node metastasis (CLNM), maximum tumor diameter (MTD), serum calcitonin (Ctn), and carcinoembryonic antigen (CEA) as significantly associated with LLNM (P &amp;lt; 0.05). Multivariate logistic regression analysis revealed ETE (OR = 14.37; 95% CI: 2.11\u2013100.24; P = 0.007), CLNM (OR = 4.97; 95% CI: 1.06\u201323.26; P = 0.042), and natural log-transformed Ctn (Ln_Ctn) (OR = 2.72; 95% CI: 1.49\u20134.99; P&amp;lt;0.001) as independent predictors. The resulting nomogram demonstrated excellent discriminative ability (AUC = 0.941), good calibration, and strong clinical utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We developed a novel nomogram incorporating ETE, CLNM, and Ln_Ctn to accurately estimate LLNM probability in MTC patients. This predictive model significantly improves risk stratification, provides valuable guidance for surgical decision-making regarding LLND, and supports personalized surgical planning.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1648529","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T04:12:58Z","timestamp":1758255178000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Development and validation of a novel nomogram for predicting lateral lymph node metastasis in medullary thyroid carcinoma"],"prefix":"10.3389","volume":"16","author":[{"given":"KeJie","family":"Yu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XianJiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WeiDong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1089\/thy.2014.0335","article-title":"Revised american thyroid association guidelines for the management of medullary thyroid carcinoma","volume":"25","author":"Wells","year":"2015","journal-title":"Thyroid"},{"key":"B2","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1007\/s12022-021-09664-3","article-title":"Genomics and epigenomics of medullary thyroid carcinoma: from sporadic disease to familial manifestations","volume":"32","author":"Barletta","year":"2021","journal-title":"Endocrine Pathol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1080\/14737140.2022.2089118","article-title":"Medullary thyroid carcinoma: a narrative historical review","volume":"22","author":"Wong","year":"2022","journal-title":"Expert Rev Anticancer Ther"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e13884","DOI":"10.1097\/MD.0000000000013884","article-title":"Prognostic value of numbers of metastatic lymph node in medullary thyroid carcinoma","volume":"98","author":"Meng","year":"2019","journal-title":"Medicine"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.883429","article-title":"Nomogram for preoperative estimation risk of cervical lymph node metastasis in medullary thyroid carcinoma","volume":"12","author":"Luo","year":"2022","journal-title":"Front Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-023-03485-6","article-title":"Appropriate and mindful measurement of serum calcitonin in patients with thyroid nodules. 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