A new ctDNA methylation-based model shows promise for preoperatively identifying lymph node metastasis in colorectal cancer, influencing surgical decisions.

• Sensitivity of 82.6% and specificity of 73.3% for identifying lymph node metastasis.
• Outperforms traditional CT imaging (77.2% vs. 66.5%, p = 0.019).

This could help refine the need for D3 lymphadenectomy in surgical planning.

• The new nomogram also predicts D3 metastasis with accuracy of 82.6%, compared to 67.4% with traditional methods (p < 0.001).