{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T19:25:22Z","timestamp":1769196322050,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) within the Priority Programme SPP 2177 Radiomics","award":["PE 1711\/2\u20131"],"award-info":[{"award-number":["PE 1711\/2\u20131"]}]},{"name":"Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) within the Priority Programme SPP 2177 Radiomics","award":["PE 1711-2-2"],"award-info":[{"award-number":["PE 1711-2-2"]}]},{"name":"Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) within the Priority Programme SPP 2177 Radiomics","award":["BA 6438\/4\u20131"],"award-info":[{"award-number":["BA 6438\/4\u20131"]}]},{"name":"Bruno and Helene J\u00f6ster Foundation within the AI4Onco project"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Accurate assessment of lymph nodes is of paramount importance for correct cN staging in head and neck cancer; however, it is very time-consuming for radiologists, and lymph node metastases of head and neck cancers may show distinct characteristics, such as central necrosis or very large size. Here, we evaluate the performance of a previously developed generic cervical lymph node segmentation model in a cohort of patients with head and neck cancer. Methods: In our retrospective single-center, multi-vendor study, we included 125 patients with head and neck cancer with at least one untreated lymph node metastasis. On the respective cervical CT scan, an experienced radiologist segmented lymph nodes semi-automatically. All 3D segmentations were confirmed by a second reader. These manual segmentations were compared to segmentations generated by an AI model previously trained on a different dataset of varying cancers. Results: In cervical CT scans from 125 patients (61.9 years \u00b1 10.6, 100 men), 3656 lymph nodes were segmented as ground-truth, including 544 clinical metastases. The AI achieved an average recall of 0.70 with 6.5 false positives per CT scan. The average global Dice accounts for 0.73 per scan, with an average Hausdorff distance of 0.88 mm. When analyzing the individual nodes, segmentation accuracy was similar for non-metastatic and metastatic lymph nodes, with a sensitivity of 0.89 and 0.85. Localization performance was lower for metastatic than for non-metastatic lymph nodes, with a recall of 0.65 and 0.74, respectively. Model performance was worse for enlarged nodes (short-axis diameter \u2265 15 mm), with a recall of 0.36 and a sensitivity of 0.67. Conclusions: The AI model for generic cervical lymph node segmentation shows good performance for smaller nodes (SAD \u2264 15 mm) with respect to localization and segmentation accuracy. However, for clearly enlarged and necrotic nodes, a retraining of the generic AI algorithm seems to be required for accurate cN staging.<\/jats:p>","DOI":"10.3390\/diagnostics16020355","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T15:31:46Z","timestamp":1769009506000},"page":"355","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Automated Lymph Node Localization and Segmentation in Patients with Head and Neck Cancer: Opportunities and Limitations of Using a Generic AI Model"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3980-931X","authenticated-orcid":false,"given":"Miriam","family":"Rinneburger","sequence":"first","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6747-6578","authenticated-orcid":false,"given":"Heike","family":"Carolus","sequence":"additional","affiliation":[{"name":"Philips Innovative Technologies, 22335 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3694-0235","authenticated-orcid":false,"given":"Andra-Iza","family":"Iuga","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6536-3898","authenticated-orcid":false,"given":"Mathilda","family":"Weisthoff","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Lennartz","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7928-0487","authenticated-orcid":false,"given":"Nils","family":"Gro\u00dfe Hokamp","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9530-5899","authenticated-orcid":false,"given":"Liliana Lourenco","family":"Caldeira","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astha","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Maintz","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3761-0350","authenticated-orcid":false,"given":"Fabian Christopher","family":"Laqua","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, RoMed Klinikum Rosenheim, 83022 Rosenheim, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Bae\u00dfler","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, University Hospital W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Klinder","sequence":"additional","affiliation":[{"name":"Philips Innovative Technologies, 22335 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5928-4405","authenticated-orcid":false,"given":"Thorsten","family":"Persigehl","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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