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Enhancing Node-RADS for preoperative assessment of cervical lymph node metastases in papillary thyroid carcinoma: validation and modification.

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Title: Enhancing Node-RADS for preoperative assessment of cervical lymph node metastases in papillary thyroid carcinoma: validation and modification.
Authors: Wang, Yanjun1 (AUTHOR), Hou, Jinlu2 (AUTHOR), Chen, Xunjun2 (AUTHOR), Wang, Yuancheng1 (AUTHOR), Ju, Shenghong1 (AUTHOR) jsh@seu.edu.cn
Source: European Radiology. Jul2026, Vol. 36 Issue 7, p6068-6081. 14p.
Subjects: Lymphatic metastasis, Computed tomography, Evaluation methodology, Prognostic tests, Preoperative care, Thyroid cancer
Abstract: Objectives: To evaluate the diagnostic performance of the Node Reporting and Data System (Node-RADS) and its enhanced versions for central (CLNM) and lateral lymph node metastases (LLNM) in papillary thyroid cancer (PTC). Materials and methods: This retrospective study enrolled 227 patients with histologically confirmed PTC who underwent preoperative thyroid-dedicated contrast-enhanced CT. The original Node-RADS scores were assigned to lymph nodes in cervical levels II–VI, and the results were compared with histopathology. A Hyper‑Enhancement Node‑RADS (HE‑Node‑RADS) model by assigning a hyper‑enhancement feature was further developed. Multivariate logistic regression was used to identify independent predictors of CLNM and construct a Nomogram‑Augmented Node‑RADS (NA‑Node‑RADS). The diagnostic performance of different thresholds of Node-RADS and the modified models was assessed and compared. Results: Node-RADS demonstrated moderate to good diagnostic performance for both CLNM (threshold > 1, AUC = 0.741) and LLNM (threshold > 2, AUC = 0.801). Interobserver agreements were excellent (κ = 0.838 for CLNM and κ = 0.827 for LLNM). At threshold > 2, HE-Node-RADS (AUC = 0.883) was significantly superior to Node-RADS for LLNM (p = 0.004). NA-Node-RADS (predicted probability > 47.1%), incorporating age, sex, primary tumor size, and core node features (texture, border, shape), showed superior predictive power for CLNM (AUC = 0.879) compared to Node-RADS (0.795) and HE-Node-RADS (0.807), with good calibration and superior net benefit on decision curve analysis. Conclusion: CT‑based Node‑RADS offered robust LNM assessment in PTC. The addition of hyper-enhancement improves Node-RADS performance for LLNM, and the proposed nomogram based on Node-RADS further refines CLNM risk estimation. Key Points: QuestionHow about the Node-RADS for lymph node metastasis (LNM) assessment in papillary thyroid cancer (PTC), and can it be improved? FindingsNode-RADS demonstrates moderate to good diagnostic efficacy. Hyper‑enhancement Node‑RADS and Nomogram‑Augmented Node‑RADS are significantly superior for lateral and central LNM, respectively. Clinical relevanceNode‑RADS is useful for preoperative assessment of LNM in PTC, but thresholds vary by neck compartment. Integrating hyper-enhancement enhances lateral Node-RADS performance, while incorporating clinical factors improves central Node-RADS and may facilitate individualized clinical decision-making. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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DbLabel: Engineering Source
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  Label: Title
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  Data: Enhancing Node-RADS for preoperative assessment of cervical lymph node metastases in papillary thyroid carcinoma: validation and modification.
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  Data: <searchLink fieldCode="AR" term="%22Wang%2C+Yanjun%22">Wang, Yanjun</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hou%2C+Jinlu%22">Hou, Jinlu</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chen%2C+Xunjun%22">Chen, Xunjun</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wang%2C+Yuancheng%22">Wang, Yuancheng</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ju%2C+Shenghong%22">Ju, Shenghong</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> jsh@seu.edu.cn</i>
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Jul2026, Vol. 36 Issue 7, p6068-6081. 14p.
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  Label: Subjects
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  Data: <searchLink fieldCode="DE" term="%22Lymphatic+metastasis%22">Lymphatic metastasis</searchLink><br /><searchLink fieldCode="DE" term="%22Computed+tomography%22">Computed tomography</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+methodology%22">Evaluation methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Prognostic+tests%22">Prognostic tests</searchLink><br /><searchLink fieldCode="DE" term="%22Preoperative+care%22">Preoperative care</searchLink><br /><searchLink fieldCode="DE" term="%22Thyroid+cancer%22">Thyroid cancer</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives: To evaluate the diagnostic performance of the Node Reporting and Data System (Node-RADS) and its enhanced versions for central (CLNM) and lateral lymph node metastases (LLNM) in papillary thyroid cancer (PTC). Materials and methods: This retrospective study enrolled 227 patients with histologically confirmed PTC who underwent preoperative thyroid-dedicated contrast-enhanced CT. The original Node-RADS scores were assigned to lymph nodes in cervical levels II–VI, and the results were compared with histopathology. A Hyper‑Enhancement Node‑RADS (HE‑Node‑RADS) model by assigning a hyper‑enhancement feature was further developed. Multivariate logistic regression was used to identify independent predictors of CLNM and construct a Nomogram‑Augmented Node‑RADS (NA‑Node‑RADS). The diagnostic performance of different thresholds of Node-RADS and the modified models was assessed and compared. Results: Node-RADS demonstrated moderate to good diagnostic performance for both CLNM (threshold > 1, AUC = 0.741) and LLNM (threshold > 2, AUC = 0.801). Interobserver agreements were excellent (κ = 0.838 for CLNM and κ = 0.827 for LLNM). At threshold > 2, HE-Node-RADS (AUC = 0.883) was significantly superior to Node-RADS for LLNM (p = 0.004). NA-Node-RADS (predicted probability > 47.1%), incorporating age, sex, primary tumor size, and core node features (texture, border, shape), showed superior predictive power for CLNM (AUC = 0.879) compared to Node-RADS (0.795) and HE-Node-RADS (0.807), with good calibration and superior net benefit on decision curve analysis. Conclusion: CT‑based Node‑RADS offered robust LNM assessment in PTC. The addition of hyper-enhancement improves Node-RADS performance for LLNM, and the proposed nomogram based on Node-RADS further refines CLNM risk estimation. Key Points: QuestionHow about the Node-RADS for lymph node metastasis (LNM) assessment in papillary thyroid cancer (PTC), and can it be improved? FindingsNode-RADS demonstrates moderate to good diagnostic efficacy. Hyper‑enhancement Node‑RADS and Nomogram‑Augmented Node‑RADS are significantly superior for lateral and central LNM, respectively. Clinical relevanceNode‑RADS is useful for preoperative assessment of LNM in PTC, but thresholds vary by neck compartment. Integrating hyper-enhancement enhances lateral Node-RADS performance, while incorporating clinical factors improves central Node-RADS and may facilitate individualized clinical decision-making. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1007/s00330-026-12403-z
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 14
        StartPage: 6068
    Subjects:
      – SubjectFull: Lymphatic metastasis
        Type: general
      – SubjectFull: Computed tomography
        Type: general
      – SubjectFull: Evaluation methodology
        Type: general
      – SubjectFull: Prognostic tests
        Type: general
      – SubjectFull: Preoperative care
        Type: general
      – SubjectFull: Thyroid cancer
        Type: general
    Titles:
      – TitleFull: Enhancing Node-RADS for preoperative assessment of cervical lymph node metastases in papillary thyroid carcinoma: validation and modification.
        Type: main
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      – PersonEntity:
          Name:
            NameFull: Wang, Yanjun
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            NameFull: Hou, Jinlu
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            NameFull: Chen, Xunjun
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            NameFull: Wang, Yuancheng
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            NameFull: Ju, Shenghong
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            – D: 01
              M: 07
              Text: Jul2026
              Type: published
              Y: 2026
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              Value: 36
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            – TitleFull: European Radiology
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