{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:04:47Z","timestamp":1789621487511,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"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>The lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) lie deep in the right central compartment. Clearing them is technically demanding and adds to the risk of injury to the nerve and parathyroid glands, whereas occult metastases left behind may cause persistent or recurrent disease. Knowing in advance which patients are likely to have LN-prRLN metastasis would help tailor the extent of central neck dissection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 320 patients with papillary thyroid carcinoma (PTC) treated at a single tertiary center between August 2021 and February 2026, all of whom underwent thyroidectomy with right central neck dissection that included separate LN-prRLN harvesting. Candidate clinicopathological variables were screened by univariable logistic regression; non-redundant binary variables with P&amp;lt;0.05 then entered a multivariable Firth penalized-likelihood model, used because a single event among the 166 central-node-negative patients biased the ordinary maximum-likelihood estimate. The independent predictors formed a nomogram, internally validated by 1,000 bootstrap resamples that repeated the entire model-building procedure, and was assessed for discrimination, calibration (including the optimism-corrected calibration slope and the Hosmer\u2013Lemeshow test) and clinical utility (decision curve analysis, DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LN-prRLN metastasis was present in 51 of 320 patients (15.9%). Multifocality (odds ratio [OR] 4.46), tumor diameter &amp;gt;10\u00a0mm (OR 2.87), isthmic\/near-isthmic location (OR 6.28), central lymph node metastasis (OR 49.15) and lateral lymph node metastasis (OR 13.90) were independent predictors (all P&amp;lt;0.05), whereas capsular invasion was not retained (P\u00a0=\u00a00.286). The resulting nomogram reached an area under the receiver operating characteristic curve of 0.936 (95% confidence interval 0.901\u20130.971; optimism-corrected 0.927), with a sensitivity of 0.843 and a specificity of 0.896 at the optimal cutoff of 0.226. Calibration curves lay close to the ideal line (optimism-corrected calibration slope 0.961, intercept \u22120.024; Hosmer\u2013Lemeshow P\u00a0=\u00a00.285), and DCA showed a positive net benefit across the clinically plausible range of threshold probabilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A nomogram combining multifocality, tumor size, isthmic location, and central and lateral compartment metastasis predicted LN-prRLN metastasis with high discrimination and acceptable internal calibration. Intended for use with preoperative, imaging-based assessment of nodal status, the nomogram requires external validation, ideally multicenter and prospective, before routine use. It should be emphasized, however, that central and lateral nodal status \u2014 the two strongest predictors \u2014 were coded from the final histopathological report, and because the sensitivity of preoperative ultrasound and contrast-enhanced computed tomography for central compartment metastasis is limited, the performance reported here is an upper bound on what can be expected when the nomogram is used with imaging-based inputs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1953516","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:46:30Z","timestamp":1789620390000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of a nomogram for predicting lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma: a single-center retrospective study"],"prefix":"10.3389","volume":"17","author":[{"given":"Qiran","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Thyroid and Breast Surgery, The Fourth Affiliated Hospital of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luxin","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery, The Fourth Affiliated Hospital of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery, The Fourth Affiliated Hospital of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"B1","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":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-001-0176-3","article-title":"Pattern of nodal metastasis for primary and reoperative thyroid cancer","volume":"26","author":"Machens","year":"2002","journal-title":"World J Surg"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1187825","article-title":"Multimodal predictive factors of metastasis in lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma","volume":"14","author":"Gong","year":"2023","journal-title":"Front Endocrinol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-025-09503-9","article-title":"Predictive factors of metastasis in lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma","volume":"282","author":"Cao","year":"2025","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.914946","article-title":"Pattern and predictive factors of metastasis in lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma","volume":"13","author":"Zhou","year":"2022","journal-title":"Front Endocrinol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.21037\/gs-21-177","article-title":"A meta-analysis of risk factors for lymph node posterior to the right recurrent laryngeal nerve metastasis in papillary thyroid carcinoma","volume":"10","author":"Zhou","year":"2021","journal-title":"Gland Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7064328","article-title":"Risk factors for predicting lymph nodes posterior to right recurrent laryngeal nerve (LN-prRLN) metastasis in thyroid papillary carcinoma: a meta-analysis","volume":"2019","author":"Li","year":"2019","journal-title":"Int J Endocrinol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S167997","article-title":"Model of lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma","volume":"10","author":"Luo","year":"2018","journal-title":"Cancer Manag Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2147\/OTT.S220926","article-title":"Individualized prediction of metastatic involvement of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma","volume":"12","author":"Zhu","year":"2019","journal-title":"Onco Targets Ther"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1177\/14574969261440429","article-title":"Predicting lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma: a risk model based on prelaryngeal and paratracheal lymph nodes","author":"Deng","year":"2026","journal-title":"Scand J Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.12.9791","article-title":"How to build and interpret a nomogram for cancer prognosis","volume":"26","author":"Iasonos","year":"2008","journal-title":"J Clin Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.1098204","article-title":"Risk prediction for central lymph node metastasis in isolated isthmic papillary thyroid carcinoma by nomogram: a retrospective study from 2010 to 2021","volume":"13","author":"Zhao","year":"2023","journal-title":"Front Endocrinol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-010-0985-4","article-title":"The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM","volume":"17","author":"Edge","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m441","article-title":"Calculating the sample size required for developing a clinical prediction model","volume":"368","author":"Riley","year":"2020","journal-title":"BMJ"},{"key":"B16","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"Firth","year":"1993","journal-title":"Biometrika"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/s0895-4356(01)00341-9","article-title":"Internal validation of predictive models: efficiency of some procedures for logistic regression analysis","volume":"54","author":"Steyerberg","year":"2001","journal-title":"J Clin Epidemiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s12916-019-1466-7","article-title":"Calibration: the Achilles heel of predictive analytics","volume":"17","author":"Van Calster","year":"2019","journal-title":"BMC Med"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X06295361","article-title":"Decision curve analysis: a novel method for evaluating prediction models","volume":"26","author":"Vickers","year":"2006","journal-title":"Med Decis Making"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i6","article-title":"Net benefit approaches to the evaluation of prediction models, molecular markers, and diagnostic tests","volume":"352","author":"Vickers","year":"2016","journal-title":"BMJ"},{"key":"B23","doi-asserted-by":"publisher","first-page":"55","DOI":"10.7326\/M14-0697","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement","volume":"162","author":"Collins","year":"2015","journal-title":"Ann Intern Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-011-1409-8","article-title":"Correlation between the number of nodal metastases and the pattern of distant spread in papillary and medullary thyroid cancer","volume":"36","author":"Machens","year":"2012","journal-title":"World J Surg"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.139.1.43","article-title":"Skip metastases in thyroid cancer leaping the central lymph node compartment","volume":"139","author":"Machens","year":"2004","journal-title":"Arch Surg"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2007.0269","article-title":"Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound and computed tomography","volume":"18","author":"Kim","year":"2008","journal-title":"Thyroid"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-051568","article-title":"Diagnostic accuracy of ultrasound, CT and their combination in detecting cervical lymph node metastasis in patients with papillary thyroid cancer: a systematic review and meta-analysis","volume":"12","author":"Yang","year":"2022","journal-title":"BMJ Open"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1953516\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:46:45Z","timestamp":1789620405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1953516\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":27,"alternative-id":["10.3389\/fendo.2026.1953516"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1953516","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"article-number":"1953516"}}