World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://wjon.elmerpub.com

Original Article

Volume 17, Number 3, June 2026, pages 412-418

Could Pretreatment Computed Tomography Imaging Accurately Predict the Pathological Diagnosis of Lymph Node Involvement in Thymic Epithelial Tumors?

↓ Figure 1. Preoperative CT images of (a) a 52-year-old male and (b) a 49-year-old female with World Health Organization (WHO) classification B3. All three radiologists evaluated right upper paratracheal LN metastasis, and the pathological report proved the positive findings. Ao: aorta; SVC: superior vena cava; CT: computed tomography; LN: lymph node.

↓ Figure 2. Preoperative CT images of (a) a 59-year-old female and (b) a 74-year-old male with World Health Organization (WHO) classification thymic carcinoma. All three radiologists evaluated LN metastasis in the aortopulmonary window, and the pathological report proved the positive findings. Ao: aorta; SVC: superior vena cava; CT: computed tomography; LN: lymph node.

↓ **Table 1.** Basic Characteristics of TETs Patients Receiving Operation and Mediastinal Lymph Node Dissection
	Patients (n = 30)	Range or %
TETs: thymic epithelial tumors; CT: computed tomography; VATS: video-assisted thoracoscopic surgery; RATS: robotic-assisted thoracic surgery; WHO: World Health Organization; M-K: Masaoka-Koga.
Gender, male (%)	13	43.3%
Operation age, year	57.3 ± 10.9	38–74
Preoperative CT tumor size, cm	5.6 ± 2.7	2–11.5
Preoperative chemotherapy or radiation	3	10%
Operation method
Median sternotomy	9	30%
Lateral thoracotomy	2	6.7%
VATS	14	46.7%
RATS	5	16.7%
Lymph node harvest
N1	30	100%
N2	3	10%
Mediastinal lymph node metastasis	4	13.3%
M-K stage
I	11	36.7%
IIa	4	13.3%
IIb	2	6.7%
III	7	23.3%
IVa	1	3.3%
IVb	4	13.3%
WHO histotype
A + AB + B1 (low risk)	11	36.7%
B2 + B3 (moderate risk)	9	30%
Micronodular thymoma with lymphoid stroma	1	3.3%
Carcinoma	9	30%

↓ Table 1. Basic Characteristics of TETs Patients Receiving Operation and Mediastinal Lymph Node Dissection

Patients (n = 30)

Range or %

TETs: thymic epithelial tumors; CT: computed tomography; VATS: video-assisted thoracoscopic surgery; RATS: robotic-assisted thoracic surgery; WHO: World Health Organization; M-K: Masaoka-Koga.

Gender, male (%)

43.3%

Operation age, year

57.3 ± 10.9

38–74

Preoperative CT tumor size, cm

5.6 ± 2.7

2–11.5

Preoperative chemotherapy or radiation

10%

Operation method

Median sternotomy

30%

Lateral thoracotomy

6.7%

VATS

46.7%

RATS

16.7%

Lymph node harvest

100%

10%

Mediastinal lymph node metastasis

13.3%

M-K stage

36.7%

IIa

13.3%

IIb

6.7%

III

23.3%

IVa

3.3%

IVb

13.3%

WHO histotype

A + AB + B1 (low risk)

36.7%

B2 + B3 (moderate risk)

30%

Micronodular thymoma with lymphoid stroma

3.3%

Carcinoma

30%

↓ **Table 2.** Evaluation of Sensitivity, Specificity, and Predictive Values by Identifying TETs Lymph Node Metastasis From CT Image
	TP	FP	TN	FN	Sensitivity	Specificity	PPV	NPV	Accuracy
Mediastinal lymph node metastasis was recorded in four patients with TETs in the pathology reports. TETs: thymic epithelial tumors; CT: computed tomography; TP: true positive; FP: false positive; TN: true negative; FN: false negative; PPV: positive predictive value; NPV: negative predictive value.
TETs (n = 30)
Radiologist A	4	2	24	0	100%	92.3%	66.7%	100%	93.3%
Radiologist B	4	10	16	0	100%	61.5%	28.6%	100%	66.7%
Radiologist C	4	6	20	0	100%	76.9%	40%	100%	80%

↓ Table 2. Evaluation of Sensitivity, Specificity, and Predictive Values by Identifying TETs Lymph Node Metastasis From CT Image

Sensitivity

Specificity

PPV

NPV

Accuracy

Mediastinal lymph node metastasis was recorded in four patients with TETs in the pathology reports. TETs: thymic epithelial tumors; CT: computed tomography; TP: true positive; FP: false positive; TN: true negative; FN: false negative; PPV: positive predictive value; NPV: negative predictive value.

TETs (n = 30)

Radiologist A

100%

92.3%

66.7%

100%

93.3%

Radiologist B

100%

61.5%

28.6%

100%

66.7%

Radiologist C

100%

76.9%

40%

100%

80%

↓ **Table 3.** Previous Studies for TETs LN Metastasis
	Years of inclusion	Lymph node harvest patient numbers	Lymph node metastasis rate
TETs: thymic epithelial tumors; LN: lymph node; Thy: thymoma; TC: thymic carcinoma; NETT: neuroendocrine thymic tumor.
Kondo et al, 2003, [10]	1990–1994	Thy: 1,064	1.8%
		TC: 183	26.8%
Park et al, 2013 [11]	1995–2010	TC: 26	23.1%
Weissferdt et al, 2012 [12]	1985–2011	TC: 30	36.7%
Weksler et al, 2015 [13]	1988–2009	Thy: 442	13.3%
Weksler et al, 2015 [14]	1988–2011	TC: 176	64.1%
		NETT: 53	35.9%
Hwang et al, 2016 [15]	1996–2011	Thy: 99	5.1%
		TC: 32	25.0%
Fang et al, 2018 [16]	2014–2016	Thy: 243	2.1%
		TC: 24	25.0%
		NETT: 8	50.0%
Current study	2008–2023	Thy: 21	9.5%
		TC: 9	22.2%

↓ Table 3. Previous Studies for TETs LN Metastasis

Years of inclusion

Lymph node harvest patient numbers

Lymph node metastasis rate

TETs: thymic epithelial tumors; LN: lymph node; Thy: thymoma; TC: thymic carcinoma; NETT: neuroendocrine thymic tumor.

Kondo et al, 2003, [10]

1990–1994

Thy: 1,064

1.8%

TC: 183

26.8%

Park et al, 2013 [11]

1995–2010

TC: 26

23.1%

Weissferdt et al, 2012 [12]

1985–2011

TC: 30

36.7%

Weksler et al, 2015 [13]

1988–2009

Thy: 442

13.3%

Weksler et al, 2015 [14]

1988–2011

TC: 176

64.1%

NETT: 53

35.9%

Hwang et al, 2016 [15]

1996–2011

Thy: 99

5.1%

TC: 32

25.0%

Fang et al, 2018 [16]

2014–2016

Thy: 243

2.1%

TC: 24

25.0%

NETT: 8

50.0%

Current study

2008–2023

Thy: 21

9.5%

TC: 9

22.2%