{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:25:26Z","timestamp":1787117126988,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thyroid cancer is one of the fastest-growing malignancies worldwide, with papillary thyroid carcinoma (PTC) accounting for approximately 85-90% of all cases. For patients with T1b-T2 PTC, the choice between thyroid lobectomy and total thyroidectomy remains controversial. Postoperative pathological examination reveals contralateral occult carcinoma in 20-40% of patients, while contralateral central lymph node metastasis (CLNM) represents a key prognostic factor. However, reliable and practical preoperative tools to support individualized surgical decision-making are currently lacking. This study aimed to develop and validate a preoperative prediction model for assessing the risk of contralateral occult carcinoma (OTC) and contralateral CLNM in patients with T1b-T2 PTC, thereby facilitating individualized surgical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study enrolled 932 patients with T1b-T2 PTC who presented with unilateral nodules on preoperative ultrasound and underwent total thyroidectomy with bilateral central lymph node dissection. All 932 patients were included in the contralateral OTC prediction model, and 730 patients were included in the contralateral CLNM prediction model. Nine machine learning algorithms and logistic regression models were trained and compared using five-fold cross-validation. Key predictive features were selected through multivariate logistic regression and random forest. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, the Hosmer Lemeshow test, and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Feature selection identified four independent predictors of contralateral OTC: malignant isthmic nodule, sum of the longest diameter (SLD), number of malignant nodules, and capsular disruption. Five predictors were identified for contralateral CLNM: isthmus adjacent nodule, sex, SLD, age, and chronic lymphocytic thyroiditis (CLT), with CLT showing a negative association with CLNM.<\/jats:p>\n                    <jats:p>Logistic regression model demonstrated the best performance for OTC prediction (AUC\u00a0=\u00a082.00%). For contralateral CLNM, logistic regression achieved an AUC of 79.00%, comparable to that of the best-performing machine learning model (glmBoost, AUC\u00a0=\u00a079.10%), with no statistically significant difference observed between the two models. Model calibration was satisfactory, as demonstrated by calibration curves and the Hosmer\u2013Lemeshow test (P\u00a0=\u00a00.5097). Decision curve analysis further indicated favorable clinical net benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study developed a logistic regression-based preoperative predictive tool to assess the individualized risk of contralateral occult carcinoma and contralateral CLNM in patients with T1b-T2 PTC. To our knowledge, this is the first dual-outcome prediction model specifically designed for this patient population. The prediction results were visualized using two nomograms and two web-based applications, which may assist clinicians in making individualized surgical decisions before surgery. Specifically, low-risk patients may be considered for thyroid lobectomy to avoid overtreatment, whereas high risk-patients may undergo total thyroidectomy to reduce the risk of recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1891976","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T04:38:37Z","timestamp":1787114317000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a preoperative nomogram for predicting contralateral occult carcinoma and central lymph node metastasis in T1b-T2 stage papillary thyroid carcinoma"],"prefix":"10.3389","volume":"17","author":[{"given":"Yu","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runze","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuming","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalan","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunping","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2017.04.011","article-title":"Thyroid cancer","volume":"401","author":"Chen","year":"2023","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.26348","article-title":"Thyroid cancer: a review","volume":"331","author":"Boucai","year":"2024","journal-title":"JAMA"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26115173","article-title":"Thyroid cancer: epidemiology, classification, risk factors, diagnostic and prognostic markers, and current treatment strategies","volume":"26","author":"Forma","year":"2025","journal-title":"Int J Mol Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jncc.2024.01.006","article-title":"Cancer incidence and mortality in China, 2022","volume":"4","author":"Han","year":"2024","journal-title":"J Natl Cancer Cent"},{"key":"B5","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1089\/thy.2021.0557","article-title":"Trends in the management of localized papillary thyroid carcinoma in the United States (2000-2018)","volume":"32","author":"Pasqual","year":"2022","journal-title":"Thyroid"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.soc.2022.10.011","article-title":"Lobectomy or total thyroidectomy-where is the pendulum now for differentiated thyroid cancer","volume":"32","author":"Fackelmayer","year":"2023","journal-title":"Surg Oncol Clin N Am"},{"key":"B7","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1016\/j.suc.2019.04.003","article-title":"Extent of surgery for low-risk differentiated thyroid cancer","volume":"99","author":"Mcdow","year":"2019","journal-title":"Surg Clin North Am"},{"key":"B8","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":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-020-00728-3","article-title":"Transcutaneous laryngeal ultrasonography: a reliable, non-invasive and inexpensive preoperative method in the evaluation of vocal cords motility-a prospective multicentric analysis on a large series and a literature review","volume":"72","author":"Gambardella","year":"2020","journal-title":"Updates Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.14216\/kjco.20006","article-title":"Risk factor for contralateral occult carcinoma in patients with unilateral papillary thyroid carcinoma","volume":"16","author":"Ahn","year":"2020","journal-title":"Korean J Clin Oncol"},{"key":"B11","article-title":"Incidental thyroid carcinoma: a multicentric experience","volume":"101","author":"Pezzolla","year":"2010","journal-title":"Recenti Progressi Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.21037\/gs-19-157","article-title":"Predictive factors of contralateral occult carcinoma in patients with papillary thyroid carcinoma: a retrospective study","volume":"9","author":"Chen","year":"2020","journal-title":"Gland Surg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.675643","article-title":"Risk factors for contralateral occult carcinoma in patients with unilateral papillary thyroid carcinoma: a retrospective study and meta-analysis","volume":"12","author":"Zhang","year":"2021","journal-title":"Front Endocrinol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2020.01.023","article-title":"Predictive factors for occult bilateral papillary thyroid carcinoma","volume":"28","author":"Wang","year":"2021","journal-title":"Acad Radiol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.7314\/apjcp.2015.16.7.2947","article-title":"The braft1799a mutation is not associated with occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma","volume":"16","author":"Wan","year":"2015","journal-title":"Asian Pac J Cancer Prev"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14215266","article-title":"Evaluation of cervical lymph node metastasis in papillary thyroid carcinoma using clinical-ultrasound radiomic machine learning-based model","volume":"14","author":"Agyekum","year":"2022","journal-title":"Cancers"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12113641","article-title":"Prediction of cervical lymph node metastasis in clinically node-negative t1 and t2 papillary thyroid carcinoma using supervised machine learning approach","volume":"12","author":"Popovi\u0107 Krneta","year":"2023","journal-title":"J Clin Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"9542","DOI":"10.1038\/s41598-025-92295-z","article-title":"Predictive risk-scoring model for lateral lymph node metastasis in papillary thyroid carcinoma","volume":"15","author":"Guo","year":"2025","journal-title":"Sci Rep"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2023.12.008","article-title":"Development and validation of clinical-radiomics nomogram for preoperative prediction of central lymph node metastasis in papillary thyroid carcinoma","volume":"31","author":"Feng","year":"2024","journal-title":"Acad Radiol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.2174\/1566524023666230915103723","article-title":"Nuclear imaging modalities in the diagnosis and management of thyroid cancer","volume":"24","author":"Singh","year":"2024","journal-title":"Curr Mol Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1186\/s13054-021-03724-0","article-title":"Machine learning model for early prediction of acute kidney injury (aki) in pediatric critical care","volume":"25","author":"Dong","year":"2021","journal-title":"Crit Care"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102913","article-title":"Development and validation of an interpretable machine learning model for predicting the risk of distant metastasis in papillary thyroid cancer: a multicenter study","volume":"77","author":"Hou","year":"2024","journal-title":"EClinicalMedicine"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2014.1","article-title":"Current thyroid cancer trends in the United States","volume":"140","author":"Davies","year":"2014","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ecl.2018.10.002","article-title":"Evolving understanding of the epidemiology of thyroid cancer","volume":"48","author":"Seib","year":"2019","journal-title":"Endocrinol Metab Clin North Am"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24201","article-title":"Postoperative nomogram for predicting disease-specific death and recurrence in papillary thyroid carcinoma","volume":"38","author":"Lang","year":"2016","journal-title":"Head Neck"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s10434-004-1165-1","article-title":"Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer","volume":"12","author":"Haigh","year":"2005","journal-title":"Ann Surg Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.14639\/0392-100x-n0608","article-title":"Total thyroidectomy versus lobectomy: surgical approach to t1-t2 papillary thyroid cancer","volume":"40","author":"Di Filippo","year":"2020","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.11138\/gchir\/2018.39.1.045","article-title":"Sutureless thyroidectomy","volume":"12","author":"Ruggiero","year":"2014","journal-title":"Int J Surg (London England)"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000347014.26767.4b","article-title":"Extent of surgery affects survival for papillary thyroid cancer","volume":"246","author":"Bilimoria","year":"2007","journal-title":"Ann Surg"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2025.109937","article-title":"Total thyroidectomy versus lobectomy for papillary thyroid cancer: a systematic review and meta-analysis","volume":"99","author":"Zhang","year":"2020","journal-title":"Medicine"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2017.00122","article-title":"The role of central neck lymph node dissection in the management of papillary thyroid cancer","volume":"7","author":"Shirley","year":"2017","journal-title":"Front Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/469397","article-title":"Factors influencing the outcome of patients with incidental papillary thyroid microcarcinoma","volume":"2012","author":"Mantinan","year":"2012","journal-title":"J Thyroid Res"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3342\/ceo.2015.8.2.174","article-title":"Multifocality and bilaterality of papillary thyroid microcarcinoma","volume":"8","author":"So","year":"2015","journal-title":"Clin Exp Otorhinolaryngol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1623075","article-title":"Construction of predictive models for contralateral occult thyroid carcinoma and central lymph node metastasis in unilateral papillary thyroid carcinoma using machine learning","volume":"15","author":"Zhao","year":"2025","journal-title":"Front Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2014.59.8391","article-title":"Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer","volume":"33","author":"Adam","year":"2015","journal-title":"J Clin Oncol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.161","article-title":"Nomograms for prediction of high-volume lymph node metastasis in papillary thyroid carcinoma patients","volume":"168","author":"Feng","year":"2023","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2013.07.021","article-title":"The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in north american patients with papillary thyroid carcinoma","volume":"154","author":"Jara","year":"2013","journal-title":"Surgery"},{"key":"B38","doi-asserted-by":"publisher","first-page":"495","DOI":"10.3727\/096504009789735431","article-title":"Clinical and biological relationship between chronic lymphocytic thyroiditis and papillary thyroid carcinoma","volume":"17","author":"Antonaci","year":"2009","journal-title":"Oncol Res"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1530\/eje-12-0903","article-title":"The association between papillary thyroid carcinoma and histologically proven hashimoto's thyroiditis: a meta-analysis","volume":"168","author":"Lee","year":"2013","journal-title":"Eur J Endocrinol"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1891976\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T04:38:43Z","timestamp":1787114323000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1891976\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":39,"alternative-id":["10.3389\/fendo.2026.1891976"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1891976","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"article-number":"1891976"}}