Self-supervised 3D deep learning on preoperative contrast-enhanced computed tomography for predicting high pathologic nodal burden in esophageal squamous cell carcinoma: temporal and external multicohort validation

Background Accurate preoperative identification of high nodal burden (pathologic N2 or N3; hereafter N2+) is important in esophageal squamous cell carcinoma, but contrast-enhanced computed tomography criteria based mainly on nodal size and morphology have limited sensitivity. Methods In this retrospective multicohort study, 1,060 consecutive patients with esophageal squamous cell carcinoma who underwent preoperative contrast-enhanced computed tomography and curative-intent esophagectomy with lym