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A retrospective cohort enrolled preoperative cT1–T2bN0M0 solid NSCLC patients treated by lobectomy with systematic LND (Jan 2021–Apr 2024). Logistic regression derived independent CT predictors and built a nomogram. The model showed AUC 0.81, sensitivity 78.1%, and specificity 73.4% at fixed 95% sensitivity specificity 39.1%.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/preoperative-contrast-enhanced-ct-features-associated-with-occult-lymph-node-metastasis-in-early-stage-solid-non-small-cell-lung-cancer/353955/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/preoperative-contrast-enhanced-ct-features-associated-with-occult-lymph-node-metastasis-in-early-stage-solid-non-small-cell-lung-cancer/353955.png","ImageObject",300,407,{"name":42,"@type":43},"Kyle","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-27","2026-09-22",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the study purpose regarding early-stage NSCLC patients?","Question",{"text":63,"@type":64},"To develop and validate a contrast-enhanced CT-based prediction model for identifying occult lymph node metastasis (OLNM) to support individualized LND strategies.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How were patients selected for the retrospective analysis?",{"text":68,"@type":64},"Patients with preoperative clinical stage I–IIA (cT1–T2bN0M0) solid NSCLC who underwent lobectomy with systematic LND between January 2021 and April 2024 were included.",{"name":70,"@type":61,"acceptedAnswer":71},"Which preoperative CT features were independent predictors of OLNM?",{"text":72,"@type":64},"A decreased inner margin ratio, the presence of the lollipop sign, and tumor-pleura relationship types II and III were independent 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Early-Stage Solid Non–Small Cell Lung Cancer  \nYuyi Feng, MM*1 • Huangqi Zhang, MD*2,7 • Jiaqian Yu, MM2 • Lingxia Wang, MD3 • Yitian Wu, MD1 • Lingwei Zhu, MM2 • Jianchen Zheng, MSc4 • Ying Chen, MM2 • Jincheng Lai, MSc4 • Hai Yang, MD2 • Tao-Hsin Tung, PhD5 • Minghui Cai, MD**6 • Wenbin Ji, MD**1,2,7  \n* Y.F. and H.Z. contributed equally to this work.  \n** M.C. and W.J. are co–senior authors.  \nAuthor affiliations, funding, and conflicts of interest are listed at the end of this article.  \nRadiology: Imaging Cancer 2026; 8(2):e250448 • [https://doi.org/10.1148/rycan.250448](https://doi.org/10.1148/rycan.250448) • Content codes:   \nPurpose: To develop and validate a contrast-enhanced CT-based prediction model for identifying occult lymph node metastasis (OLNM) in patients with early-stage non–small cell lung cancer (NSCLC), with the goal of supporting individualized lymph node dissection (LND) strategies.  \nMaterials and Methods: This retrospective study included patients with preoperative clinical stage I–IIA (cT1–T2bN0M0) solid NSCLC who underwent lobectomy with systematic LND between January 2021 and April 2024. Univariable and multivariable logistic regression analyses were used to identify independent preoperative CT predictors of OLNM and to construct a nomogram. Model performance was assessed using the area under the receiver operating characteristic curve, and specificity was evaluated at a fixed sensitivity of 95% .  \nResults: Among 329 patients with solid NSCLC (median age, 65 years; IQR, 58–70 years; 168 male patients), 22.2%(73 of 329) had OLNM, including 47.9%(35 of 73) with N1 and 52.1%(38 of 73) with N2 metastases. Independent predictors of OLNM were a decreased inner margin ratio (odds ratio [OR], 0.02; 95% CI: 0.00, 0.10; P \u003C .001), presence of the lollipop sign (OR, 3.48; 95% CI: 1.87, 6.49; P \u003C .001), and tumor-pleura relationship type II (OR, 6.95; 95% CI: 2.62, 18.44; P \u003C .001) and type III (OR, 13.27; 95% CI: 5.11, 34.45; P \u003C .001) . The nomogram achieved an area under the receiver operating characteristic curve of 0.81 (95% CI: 0.76, 0.87), with a sensitivity of 78.1% and specificity of 73.4%; specificity was 39.1% at 95% sensitivity.  \nConclusion: A contrast-enhanced CT-based nomogram incorporating inner margin ratio, lollipop sign, and tumor-pleura relationship enabled effective preoperative risk stratification for OLNM in early-stage solid NSCLC and may aid in tailoring LND strategies.  \nSupplemental material is available for this article.  \n© The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.  \nTh( e1),mfoosrcohimmchtohnechiagnhcees  \ndiagnosed worldwide is lung cancer incidence rate and number of deaths  \noccur in China (2). Approximately 85% of all lung tumors are non–small cell lung cancers (NSCLC) (3) . Since Cahan (4) proposed the definition of lobectomy (surgical excision of lung lobe) in 1960, lobectomy with systematic lymph node dissection (LND) has become the standard surgical procedure for the treatment of early-stage lung cancer (5) . Although the criterion for classifying a negative lymph node is a short-axis diameter of 10 mm or less on preoperative CT images (6), approximately 11.2%–18.5% of patients classified as N0 at preoperative imaging were found to have pathologic lymph node metastases (7–9), known as occult lymph node metastasis (OLNM) .  \nLymph node involvement is closely associated with poor prognosis in NSCLC; therefore, the current guidelines, such as those of the National Comprehensive Cancer Network and the European Society for Medical Oncology (10–11), recommend systematic rather than selective LND in patients with early-stage lung cancer. The current LND strategies, however, are controversial (12), with the Z0030 trial by the American College of Surgeons Oncology Group (13) finding that systematic and selective ","cbCaidHyCYU7zWVB","https://ap.wps.com/l/cbCaidHyCYU7zWVB","pdf",2865686,13,"English","# Purpose\n## Materials and Methods\n## Results\n## Conclusion","[{\"question\":\"What is the study purpose regarding early-stage NSCLC patients?\",\"answer\":\"To develop and validate a contrast-enhanced CT-based prediction model for identifying occult lymph node metastasis (OLNM) to support individualized LND strategies.\"},{\"question\":\"How were patients selected for the retrospective analysis?\",\"answer\":\"Patients with preoperative clinical stage I–IIA (cT1–T2bN0M0) solid NSCLC who underwent lobectomy with systematic LND between January 2021 and April 2024 were included.\"},{\"question\":\"Which preoperative CT features were independent predictors of OLNM?\",\"answer\":\"A decreased inner margin ratio, the presence of the lollipop sign, and tumor-pleura relationship types II and III were independent predictors.\"}]","Preoperative Contrast-enhanced CT Features Associated with Occult Lymph Node Metastasis in Early-Stage Solid Non - Small Cell Lung Cancer | PDF",1790108109,33]