{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T21:39:10Z","timestamp":1776980350995,"version":"3.51.4"},"reference-count":25,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Endoscopic ultrasound (EUS) is crucial for lymph node (LN) characterization, playing a key role in oncological staging and treatment guidance. EUS criteria for predicting malignancy are imprecise, and histologic diagnosis may have limitations. This multicenter study aimed to evaluate the effectiveness of a novel artificial intelligence (AI)\u2013based system in predicting LN malignancy from EUS images. Methods: This multicenter study included EUS images from nine centers. Lesions were labeled (\u201cmalignant\u201d or \u201cbenign\u201d) and delimited with bounding boxes. Definitive diagnoses were based on cytology\/biopsy or surgical specimens and, if negative, a minimum six-month clinical follow-up. A convolutional neural network (CNN) was developed using the YOLO (You Only Look Once) architecture, incorporating both detection and classification modules. Results: A total of 59,992 images from 82 EUS procedures were analyzed. The CNN distinguished malignant from benign lymph nodes with a sensitivity of 98.8% (95% CI: 98.5\u201399.2%), specificity of 99.0% (95% CI: 98.3\u201399.7%), and precision of 99.0% (95% CI: 98.4\u201399.7%). The negative and positive predictive values for malignancy were 98.8% and 99.0%, respectively. Overall diagnostic accuracy was 98.3% (95% CI: 97.6\u201399.1%). Conclusions: This is the first study evaluating the performance of deep learning systems for LN assessment using EUS imaging. Our AI-powered imaging model shows excellent detection and classification capabilities, emphasizing its potential to provide a valuable tool to refine LN evaluation with EUS, ultimately supporting more tailored, efficient patient care.<\/jats:p>","DOI":"10.3390\/cancers17213398","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T08:41:08Z","timestamp":1761122468000},"page":"3398","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Artificial Intelligence for Lymph Node Detection and Malignancy Prediction in Endoscopic Ultrasound: A Multicenter Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2504-351X","authenticated-orcid":false,"given":"Bel\u00e9n","family":"Agudo Castillo","sequence":"first","affiliation":[{"name":"Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0340-0830","authenticated-orcid":false,"given":"Miguel","family":"Mascarenhas Saraiva","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Ant\u00f3nio Miguel Martins","family":"Pinto da Costa","sequence":"additional","affiliation":[{"name":"Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain"}]},{"given":"Jo\u00e3o","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Faculty of Engineering, The University of Porto, 4200-465 Porto, Portugal"}]},{"given":"Miguel","family":"Martins","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5890-7049","authenticated-orcid":false,"given":"Francisco","family":"Mendes","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5892-9424","authenticated-orcid":false,"given":"Pedro","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Joana","family":"Mota","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Maria Jo\u00e3o","family":"Almeida","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Jo\u00e3o","family":"Afonso","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Tiago","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9759-3807","authenticated-orcid":false,"given":"Marcos Eduardo","family":"Lera dos Santos","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas da Faculdade de Medicina da USP, S\u00e3o Paulo 05403-010, Brazil"},{"name":"Vila Nova Star Hospital, S\u00e3o Paulo 04544-000, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9230-0953","authenticated-orcid":false,"given":"Matheus","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas da Faculdade de Medicina da USP, S\u00e3o Paulo 05403-010, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9393-0626","authenticated-orcid":false,"given":"Mar\u00eda","family":"Mor\u00eds","sequence":"additional","affiliation":[{"name":"Hospital Universitario Marqu\u00e9s de Valdecilla, 39008 Santander, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5498-6280","authenticated-orcid":false,"given":"Ana","family":"Garc\u00eda Garc\u00eda de Paredes","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1826-2282","authenticated-orcid":false,"given":"Daniel","family":"de la Iglesia Garc\u00eda","sequence":"additional","affiliation":[{"name":"Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain"}]},{"given":"Carlos Estebam","family":"Fern\u00e1ndez-Zarza","sequence":"additional","affiliation":[{"name":"Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain"}]},{"given":"Ana","family":"P\u00e9rez Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain"}]},{"given":"Khoon-Sheng","family":"Kok","sequence":"additional","affiliation":[{"name":"Royal Liverpool Hospital, Liverpool L7 8YE, UK"}]},{"given":"Jessica","family":"Widmer","sequence":"additional","affiliation":[{"name":"NYU Langone Health, New York, NY 10016, USA"}]},{"given":"Uzma","family":"D. Siddiqui","sequence":"additional","affiliation":[{"name":"Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, IL 60637, USA"}]},{"given":"Grace E.","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, IL 60637, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0407-6016","authenticated-orcid":false,"given":"Susana","family":"Lopes","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Pedro","family":"Moutinho Ribeiro","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"given":"Filipe","family":"Vilas-Boas","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8023-3722","authenticated-orcid":false,"given":"Eduardo","family":"Hourneaux de Moura","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas da Faculdade de Medicina da USP, S\u00e3o Paulo 05403-010, Brazil"},{"name":"Vila Nova Star Hospital, S\u00e3o Paulo 04544-000, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9387-9872","authenticated-orcid":false,"given":"Guilherme","family":"Macedo","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-1704","authenticated-orcid":false,"given":"Mariano","family":"Gonz\u00e1lez-Haba Ruiz","sequence":"additional","affiliation":[{"name":"Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1067\/mge.2001.112741","article-title":"Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma","volume":"53","author":"Norton","year":"2001","journal-title":"Gastrointest. 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