{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:40:43Z","timestamp":1785426043002,"version":"3.56.0"},"reference-count":53,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"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","award":["Z04J2024E107-B-09"],"award-info":[{"award-number":["Z04J2024E107-B-09"]}],"id":[{"id":"10.13039\/100016966","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016834","name":"Chongqing Municipal Health Commission","doi-asserted-by":"publisher","award":["2025WSJK001"],"award-info":[{"award-number":["2025WSJK001"]}],"id":[{"id":"10.13039\/100016834","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2025WSJK001"],"award-info":[{"award-number":["2025WSJK001"]}],"id":[{"id":"https:\/\/ror.org\/04ce5fg13","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Chongqing Natural Science Foundation General Project","award":["CSTB2025NSCQ-GPX0276"],"award-info":[{"award-number":["CSTB2025NSCQ-GPX0276"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Occult lymph node metastasis (LNM) occurs in 30\u201380% of patients with clinically node-negative papillary thyroid carcinoma (cN0-PTC), partly owing to the limited sensitivity of current preoperative nodal assessment, and may contribute to postoperative recurrence. Conventional sentinel lymph node (SLN) biopsy, typically performed with a single tracer, has limited reliability for detecting occult metastatic nodes, which can result in either overtreatment or undertreatment with lymph node dissection. We aimed to develop a highly accurate multimodal prediction framework to accurately identify second-echelon lymph node metastasis (SeLNM) and non-sentinel lymph node metastasis (NsLNM). Methods: We prospectively enrolled 301 patients with cN0-PTC between April and October 2024, of whom 131 met the inclusion criteria. Intraoperatively, a dual-tracer technique combining carbon nanoparticles and indocyanine green was applied, and near-infrared imaging was used to record the entire SLN visualization process in real time. For each case, a 3 min video clip (150 frames) was captured. Two senior surgeons delineated regions of interest to generate 19,650 mask images. A total of 2048 spatial features and 20 temporal features were extracted, combined with 32 clinical variables, including demographics, ultrasound characteristics, and gene mutation status. Nine deep learning models were developed and evaluated using 10-fold cross-validation. Model performance was quantified using receiver operating characteristic curves, decision curve analysis curves, calibration curves, precision\u2013recall curves, learning curves, and 12 metrics. Statistical comparisons were performed using the DeLong test, and models were further evaluated using a probability-based ranking approach. Shapley Additive Explanations (SHAP) analysis was applied to interpret key predictive features. The primary outcomes were SeLNM and NsLNM, defined based on postoperative histopathology. Results: The Long Short-Term Memory (LSTM) + Transformer model showed the best performance for both prediction tasks, with stable AUCs across training and testing (SeLNM: 0.980\/0.982; NsLNM: 0.986\/0.983). In the testing set, the model reached the same accuracy for both outcomes (94.7%) and showed strong sensitivity\/specificity for SeLNM (94.7%\/94.6%) and NsLNM (96.4%\/91.5%). SHAP analysis indicated that time-series fluorescence flow features were the most influential predictors, followed by spatial structural features and SLN status. Conclusions: Dual-tracer SLN mapping with deep learning demonstrated encouraging intraoperative prediction of lymph node metastasis with interpretable features in this single-center cohort. Independent multicenter validation and prospective outcome studies are needed before considering clinical adoption.<\/jats:p>","DOI":"10.3390\/cancers18071157","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:19:32Z","timestamp":1775434772000},"page":"1157","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dual-Tracer Imaging and Deep Learning for Real-Time Prediction of Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma"],"prefix":"10.3390","volume":"18","author":[{"given":"Jing","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Breast and Thyroid, Chongqing Health Center for Women and Children, Women and Children\u2019s Hospital of Chongqing Medical University, Chongqing 401147, China"},{"name":"Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchen","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid, Chongqing Health Center for Women and Children, Women and Children\u2019s Hospital of Chongqing Medical University, Chongqing 401147, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid, Chongqing Health Center for Women and Children, Women and Children\u2019s Hospital of Chongqing Medical University, Chongqing 401147, China"},{"name":"Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiying","family":"Yang","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuolin","family":"Dai","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Huang","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1108-9624","authenticated-orcid":false,"given":"Chang","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, The Central Hospital Affiliated Chongqing University of Technology, Chongqing 400054, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Chun","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Guangyuan Central Hospital, Guangyuan 628017, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid, Chongqing Health Center for Women and Children, Women and Children\u2019s Hospital of Chongqing Medical University, Chongqing 401147, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5792-1407","authenticated-orcid":false,"given":"Xinliang","family":"Su","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Gao, M.Z., Omer, T.M., Miller, K.M., Simpson, M.C., Bukatko, A.R., Gedion, K., Adjei Boakye, E., Kost, K.M., Dickinson, J.A., and Varvares, M.A. (2025). Thyroid Cancer Incidence and Trends in United States and Canadian Pediatric, Adolescent, and Young Adults. Cancers, 17.","DOI":"10.3390\/cancers17091429"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Yao, F., Yang, Z., Li, Y., Chen, W., Wu, T., Peng, J., Jiao, Z., and Yang, A. (2022). Real-World Evidence on the Sensitivity of Preoperative Ultrasound in Evaluating Central Lymph Node Metastasis of Papillary Thyroid Carcinoma. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.865911"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7335","DOI":"10.3390\/curroncol30080532","article-title":"Prevalence of Occult Central Lymph Node Metastasis by Tumor Size in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis","volume":"30","author":"Tang","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Chen, Y., Wang, Y., Li, C., Zhang, X., and Fu, Y. (2023). Meta-analysis of the effect and clinical significance of Delphian lymph node metastasis in papillary thyroid cancer. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1295548"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"57089","DOI":"10.18632\/oncotarget.19047","article-title":"Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancer patients with Delphian lymph node metastasis","volume":"8","author":"Zheng","year":"2017","journal-title":"Oncotarget"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"344","DOI":"10.21037\/gs-2024-508","article-title":"Development and validation of a multidimensional machine learning-based nomogram for predicting central lymph node metastasis in papillary thyroid microcarcinoma","volume":"14","author":"Liu","year":"2025","journal-title":"Gland. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e40371","DOI":"10.1097\/MD.0000000000040371","article-title":"Bilateral chylothorax following papillary thyroid carcinoma with cervical lymph node dissection: Case report and comprehensive review of the literature","volume":"103","author":"Zhou","year":"2024","journal-title":"Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Huang, H., Xu, S., Ni, S., Wang, X., and Liu, S. (2023). A nomogram for predicting lateral lymph node metastasis in cN0 unifocal papillary thyroid microcarcinoma. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-11219-0"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Yan, X.Q., Ma, Z.S., Zhang, Z.Z., Xu, D., Cai, Y.J., Wu, Z.G., Zheng, Z.Q., Xie, B.J., and Cao, F.L. (2022). The utility of sentinel Lymph node biopsy in the lateral neck in papillary thyroid carcinoma. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.937870"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Yan, X., Zeng, R., Ma, Z., Chen, C., Chen, E., Zhang, X., and Cao, F. (2015). The Utility of Sentinel Lymph Node Biopsy in Papillary Thyroid Carcinoma with Occult Lymph Nodes. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0129304"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1002\/hed.24568","article-title":"Central compartment management in patients with papillary thyroid cancer presenting with metastatic disease to the lateral neck: Anatomic pathways of lymphatic spread","volume":"39","author":"Likhterov","year":"2017","journal-title":"Head Neck"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Boschin, I.M., Bertazza, L., Scaroni, C., Mian, C., and Pelizzo, M.R. (2023). Sentinel lymph node mapping: Current applications and future perspectives in thyroid carcinoma. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1231566"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1507\/endocrj.EJ19-0409","article-title":"Sentinel lymph node biopsy in medullary thyroid microcarcinomas","volume":"67","author":"Santrac","year":"2020","journal-title":"Endocr. J."},{"key":"ref_14","first-page":"376","article-title":"Sentinel lymph node biopsy in clinically node negative patients with papillary thyroid carcinoma","volume":"25","author":"Markovic","year":"2020","journal-title":"J. BUON"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/s12020-018-1658-5","article-title":"Sentinel lymph node biopsy in small papillary thyroid cancer. A review on novel surgical techniques","volume":"62","author":"Garau","year":"2018","journal-title":"Endocrine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1053\/j.semnuclmed.2021.11.006","article-title":"Radiation Safety and Accidental Radiation Exposures in Nuclear Medicine","volume":"52","author":"Marengo","year":"2022","journal-title":"Semin. Nucl. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1908","DOI":"10.1002\/wnan.1908","article-title":"Magnetite-based Janus nanoparticles, their synthesis and biomedical applications","volume":"15","author":"Madadi","year":"2023","journal-title":"Wiley Interdiscip. Rev. Nanomed. Nanobiotechnology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s10549-024-07451-2","article-title":"Cost containment analysis of superparamagnetic iron oxide (SPIO) injection in patients with ductal carcinoma in situ","volume":"208","author":"Solis","year":"2024","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"zraf104","DOI":"10.1093\/bjsopen\/zraf104","article-title":"Indocyanine green versus technetium-99m for sentinel lymph node biopsy in breast cancer: The FLUORO trial","volume":"9","author":"Nguyen","year":"2025","journal-title":"BJS Open"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1093\/bjs\/znac311","article-title":"Ultrasound-assisted carbon nanoparticle suspension mapping versus dual tracer-guided sentinel lymph node biopsy in patients with early breast cancer (ultraCars): Phase III randomized clinical trial","volume":"109","author":"Zhang","year":"2022","journal-title":"Br. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1089\/thy.2012.0011","article-title":"Complications of central neck dissection in patients with papillary thyroid carcinoma: Results of a study on 1087 patients and review of the literature","volume":"22","author":"Giordano","year":"2012","journal-title":"Thyroid"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dolidze, D.D., Shabunin, A.V., Mumladze, R.B., Vardanyan, A.V., Covantsev, S.D., Shulutko, A.M., Semikov, V.I., Isaev, K.M., and Kazaryan, A.M. (2022). A Narrative Review of Preventive Central Lymph Node Dissection in Patients with Papillary Thyroid Cancer\u2014A Necessity or an Excess. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.906695"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"40496","DOI":"10.1109\/ACCESS.2021.3063716","article-title":"Real-Time Polyp Detection, Localization and Segmentation in Colonoscopy Using Deep Learning","volume":"9","author":"Jha","year":"2021","journal-title":"IEEE Access"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"22508","DOI":"10.1038\/s41598-024-73434-4","article-title":"Real-time segmentation of biliary structure in pure laparoscopic donor hepatectomy","volume":"14","author":"Oh","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e70153","DOI":"10.1002\/bco2.70153","article-title":"Video-endoscopic versus open inguinal lymphadenectomy: Long-term oncological outcomes in penile cancer","volume":"7","author":"Kumar","year":"2026","journal-title":"BJUI Compass"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"20552076251412694","DOI":"10.1177\/20552076251412694","article-title":"Comparison of the performance between an AI-based vision transformer and human endoscopists in predicting the endoscopic and histologic activities of ulcerative colitis","volume":"12","author":"Chang","year":"2026","journal-title":"Digit. Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3482","DOI":"10.1007\/s00259-021-05326-y","article-title":"Real-time intraoperative glioma diagnosis using fluorescence imaging and deep convolutional neural networks","volume":"48","author":"Shen","year":"2021","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Rafie, Z., Talab, M.S., Koor, B.E.Z., Garavand, A., Salehnasab, C., and Ghaderzadeh, M. (2025). Leveraging XGBoost and explainable AI for accurate prediction of type 2 diabetes. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-24953-w"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ghaderzadeh, M., Garavand, A., and Salehnasab, C. (2025). Artificial intelligence in polycystic ovary syndrome: A systematic review of diagnostic and predictive applications. BMC Med. Inform. Decis. Mak., 25.","DOI":"10.1186\/s12911-025-03255-6"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ghaderzadeh, M., Rafie, Z., and Salehnasab, C. (2026). Explainable extratreeclassifier model for early detection of type 2 diabetes: Evidence from the PERSIAN Dena Cohort. BMC Med. Inform. Decis. Mak., 26.","DOI":"10.1186\/s12911-025-03333-9"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"zraf013","DOI":"10.1093\/bjsopen\/zraf013","article-title":"Deep learning implementation for extrahepatic bile duct detection during indocyanine green fluorescence-guided laparoscopic cholecystectomy: Pilot study","volume":"9","author":"Yin","year":"2025","journal-title":"BJS Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"5091","DOI":"10.1016\/j.acra.2025.06.043","article-title":"Multimodal Deep Learning Model Based on Ultrasound and Cytological Images Predicts Risk Stratification of cN0 Papillary Thyroid Carcinoma","volume":"32","author":"He","year":"2025","journal-title":"Acad. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Du, W., Fang, Q., Zhang, X., and Dai, L. (2021). Metastasis of cN0 Papillary Thyroid Carcinoma of the Isthmus to the Lymph Node Posterior to the Right Recurrent Laryngeal Nerve. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.677986"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"22361","DOI":"10.1038\/s41598-024-73837-3","article-title":"Explainable machine learning model for predicting paratracheal lymph node metastasis in cN0 papillary thyroid cancer","volume":"14","author":"Chun","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/RLU.0000000000002378","article-title":"Sentinel Lymph Node Biopsy in Small Papillary Thyroid Cancer: A Meta-analysis","volume":"44","author":"Garau","year":"2019","journal-title":"Clin. Nucl. Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Wang, Y., Deng, C., Shu, X., Yu, P., Wang, H., Su, X., and Tan, J. (2021). Risk Factors and a Prediction Model of Lateral Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma Patients with 1-2 Central Lymph Node Metastases. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.716728"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Huang, C., Cong, S., Shang, S., Wang, M., Zheng, H., Wu, S., An, X., Liang, Z., and Zhang, B. (2021). Web-Based Ultrasonic Nomogram Predicts Preoperative Central Lymph Node Metastasis of cN0 Papillary Thyroid Microcarcinoma. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.734900"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.surg.2011.09.003","article-title":"A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer","volume":"150","author":"Popadich","year":"2011","journal-title":"Surgery"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Luo, Q.W., Gao, S., Lv, X., Li, S.J., Wang, B.F., Han, Q.Q., Wang, Y.P., Guan, Q.L., and Gong, T. (2022). A novel tool for predicting the risk of central lymph node metastasis in patients with papillary thyroid microcarcinoma: A retrospective cohort study. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-09655-5"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"8370","DOI":"10.21037\/qims-23-318","article-title":"A model for predicting lymph node metastasis of thyroid carcinoma: A multimodality convolutional neural network study","volume":"13","author":"Guang","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Li, Y., Chen, H., Zhao, Y., Yan, Q., Chen, L., and Song, Q. (2024). circUBE2G1 interacts with hnRNPU to promote VEGF-C-mediated lymph node metastasis of lung adenocarcinoma. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1455909"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"15894","DOI":"10.1073\/pnas.1208324109","article-title":"Collaborative interplay between FGF-2 and VEGF-C promotes lymphangiogenesis and metastasis","volume":"109","author":"Cao","year":"2012","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"108522","DOI":"10.1016\/j.pharmthera.2023.108522","article-title":"Cancer metastasis: Molecular mechanisms and clinical perspectives","volume":"250","author":"Khan","year":"2023","journal-title":"Pharmacol. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Holder, A.M., and Ziemys, A. (2020). Lymphatic Transport Efficiency Determines Metastatic Potential of Cutaneous Melanoma. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.01607"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s41392-023-01723-x","article-title":"Lymphatic vessel: Origin, heterogeneity, biological functions, and therapeutic targets","volume":"9","author":"Hu","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1001\/jamaoto.2023.1584","article-title":"Complex Lymphatic Drainage in Head and Neck Cutaneous Melanoma and SLNB Outcomes","volume":"149","author":"Adigbli","year":"2023","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Zhou, L., Yao, J., Ou, D., Li, M., Lei, Z., Wang, L., and Xu, D. (2022). A multi-institutional study of association of sonographic characteristics with cervical lymph node metastasis in unifocal papillary thyroid carcinoma. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.965241"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/SLA.0b013e318238f461","article-title":"Incorporation of sentinel lymph node metastasis size into a nomogram predicting nonsentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node","volume":"255","author":"Mittendorf","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s12094-025-03993-z","article-title":"Incorporating sentinel chain involvement pattern to predict non-sentinel lymph nodes status in breast cancer after neoadjuvant chemotherapy","volume":"28","author":"Liang","year":"2026","journal-title":"Clin. Transl. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"102576","DOI":"10.1016\/j.compmedimag.2025.102576","article-title":"Deep learning model for malignancy prediction of TI-RADS 4 thyroid nodules with high-risk characteristics using multimodal ultrasound: A multicentre study","volume":"124","author":"Chu","year":"2025","journal-title":"Comput. Med. Imaging Graph."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"105868","DOI":"10.1016\/j.humpath.2025.105868","article-title":"Multi-modal convolutional neural network-based thyroid cytology classification and diagnosis","volume":"161","author":"Yang","year":"2025","journal-title":"Hum. Pathol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"102298","DOI":"10.1016\/j.compmedimag.2023.102298","article-title":"A novel wavelet-transform-based convolution classification network for cervical lymph node metastasis of papillary thyroid carcinoma in ultrasound images","volume":"109","author":"Ding","year":"2023","journal-title":"Comput. Med. Imaging Graph."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1007\/s12020-024-04091-w","article-title":"Deep learning based analysis of dynamic video ultrasonography for predicting cervical lymph node metastasis in papillary thyroid carcinoma","volume":"87","author":"Qian","year":"2025","journal-title":"Endocrine"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/7\/1157\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:28:59Z","timestamp":1775435339000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/7\/1157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":53,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["cancers18071157"],"URL":"https:\/\/doi.org\/10.3390\/cancers18071157","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]}}}