Magnetic resonance imaging (MRI) is the gold standard for T- and N-staging in rectal cancer according to the 8th edition of the UICC TNM system, yet detecting locoregional metastatic lymph nodes remains challenging [1]. A recent meta-analysis reported a pooled sensitivity of 55% and specificity of 89% for MRI in assessing nodal malignancy based on node-by-node comparison with histopathology [2]. Accurate N-staging is crucial since lymph node metastases (LNMs) guide neoadjuvant treatment decision…