{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T06:09:57Z","timestamp":1772431797324,"version":"3.50.1"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016966","name":"Bethune Charitable Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016966","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016834","name":"Chongqing Municipal Health Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016834","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007957","name":"Chongqing Municipal Education Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007957","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005230","name":"Natural Science Foundation of Chongqing Municipality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005230","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Owing to the limited characterization of lymph nodes around the entrance point of the recurrent laryngeal nerve (LN-epRLN) in clinical lymph node negative (cN0) papillary thyroid carcinoma (PTC), this study sought to develop machine learning (ML) models to predict LN-epRLN metastasis, identify the optimal model, and improve interpretability using explainable artificial intelligence techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 1,800 patients with cN0-PTC who underwent central lymph node dissection (CLND) with systematic LN-epRLN sampling. Histopathological evaluation confirmed metastatic status. Patients were randomly divided into training and testing sets at a 7:3 ratio. Nine ML models were constructed and optimized through 10-fold cross-validation and grid search. Performance was assessed using 11 metrics, including AUC, accuracy, sensitivity, and specificity. The best-performing model was compared against traditional nomograms via probability-based ranking analysis (PMRA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LN-epRLNs were identified in 149 out of 1800 PTC patients, with a metastasis rate of 19.46%. The Random Forest (RF) model outperformed others, achieving training\/testing scores of 0.914\/0.911 accuracy, 0.956\/0.919 AUC, 0.993\/0.974 specificity, and 0.609\/0.500 sensitivity. A simplified model incorporating seven key predictors\u2014total central lymph node metastasis number and ratio, pretracheal lymph node metastasis number and ratio, tumor size, age, and paratracheal lymph node metastasis number\u2014retained high predictive performance. SHAPley Additive exPlanations (SHAP) analysis highlighted central compartment metastasis burden (number and ratio) as the most influential predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The interpretable ML model developed in this study, leveraging the RF, provides a reliable tool for preoperative and intraoperative prediction of LN-epRLN metastasis in cN0 PTC patients. This approach has the potential to guide individualized surgical planning, optimizing the balance between oncological resection completeness and functional preservation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1721148","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T05:21:32Z","timestamp":1772428892000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Machine learning: predicting lymph node metastasis around the entrance point to the recurrent laryngeal nerve in cN0 papillary thyroid carcinoma"],"prefix":"10.3389","volume":"17","author":[{"given":"Jie","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid, Women and Children\u2019s Hospital of Chongqing Medical University: Chongqing Health Center for Women and Children","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuping","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid, Women and Children\u2019s Hospital of Chongqing Medical University: Chongqing Health Center for Women and Children","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinliang","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, The Seventh People\u2019s Hospital of Chongqing","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1177\/10507256251363120","article-title":"2025 American thyroid association management guidelines for adult patients with differentiated thyroid cancer","volume":"35","author":"Ringel","year":"2025","journal-title":"Thyroid."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112152-20240119-00035","article-title":"Cancer incidence and mortality in China, 2022","volume":"46","author":"Zheng","year":"2024","journal-title":"Chi. 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