Diagnostic performance of Node Reporting and Data System (Node-RADS) for regional lymph node staging of gastric cancer by CT

Abstract

Objectives Diagnostic performance of imaging for regional lymph node assessment in gastric cancer is still limited, and there is a lack of consensus on radiological evaluation. At the same time, there is an increasing demand for structured reporting using Reporting and Data Systems (RADS) to standardize oncological imaging. We aimed at investigating the diagnostic performance of Node-RADS compared to the use of various individual criteria for assessing regional lymph nodes in gastric cancer using histopathology as reference. Methods In this retrospective single-center study, consecutive 91 patients (median age, 66 years, range 33–91 years, 54 men) with CT scans and histologically proven gastric adenocarcinoma were assessed using Node-RADS assigning scores from 1 to 5 for the likelihood of regional lymph node metastases. Additionally, different Node-RADS criteria as well as subcategories of altered border contour (lobulated, spiculated, indistinct) were assessed individually. Sensitivity, specificity, and Youden’s index were calculated for Node-RADS scores, and all criteria investigated. Interreader agreement was calculated using Cohen’s kappa. Results Among all criteria, best performance was found for Node-RADS scores ≥ 3 and ≥ 4 with a sensitivity/specificity/Youden’s index of 56.8%/90.7%/0.48 and 48.6%/98.1%/0.47, respectively, both with substantial interreader agreement (κ = 0.73 and 0.67, p < 0.01). Among individual criteria, the best performance was found for short-axis diameter of 10 mm with sensitivity/specificity/Youden’s index of 56.8%/87.0%/0.44 (κ = 0.65, p < 0.01). Conclusion This study shows that structured reporting of combined size and configuration criteria of regional lymph nodes in gastric cancer slightly improves overall diagnostic performance compared to individual criteria including short-axis diameter alone. The results show an increase in specificity and unchanged sensitivity. Clinical relevance statement The results of this study suggest that Node-RADS may be a suitable tool for structured reporting of regional lymph nodes in gastric cancer. Key Points • Assessment of lymph nodes in gastric cancer is still limited, and there is a lack of consensus on radiological evaluation. • Node-RADS in gastric cancer improves overall diagnostic performance compared to individual criteria including short-axis diameter. • Node-RADS may be a suitable tool for structured reporting of regional lymph nodes in gastric cancer.

Performance of MRI for standardized lymph nodes assessment in breast cancer: are we ready for Node-RADS?

“…In previous studies focused on other parts of the body, such as the prostate, the bladder, the lung, the colon, and the stomach, the Node-RADS score has already been validated and demonstrated significant utility, with favorable outcomes [12][13][14][15][16] comparable to the results obtained in our current research. Moreover, the Node-RADS score emerged as an independent predictor of lymph node involvement with a moderate-to-high overall accuracy in identifying LNI.…”

“…Moreover, the Node-RADS score emerged as an independent predictor of lymph node involvement with a moderate-to-high overall accuracy in identifying LNI. Additionally, its flexibility in allowing the establishment of different cut-off values based on specific clinical scenarios enhances its clinical applicability [12][13][14][15][16].…”

“…We retrospectively enrolled patients who were diagnosed with invasive carcinoma, and micro-invasive or high-risk ductal carcinoma in situ (DCIS) (G3, high ki67) [16] from January 2020 to July 2023, who underwent preoperative CE-MRI, breast surgery, and lymphadenectomy at our institution.…”

“…This scoring system is applicable to various tumor types at different anatomical sites, including regional and non-regional lymph nodes [11]. Although Node-RADS was introduced in 2021 and has shown promising results in prostate [12], bladder [13], lung [14], colon [15], and gastric [16] cancer, its role in BC has not previously been investigated. To address this gap, we conducted a retrospective review of preoperative CE-MRI performed in BC patients who underwent mastectomy or quadrantectomy with lymphadenectomy at our institution.…”

Comparison of the predictive performance of three lymph node staging systems for late-onset gastric cancer patients after surgery

“…Postoperative therapy is typically recommended for patients with advanced disease, such as N1 or N2 ( 10 ). The number of metastatic LNs in GC patients is a great indicator of prognosis and recurrence ( 11 ). Accurate LN staging plays a critical role in the selection of treatment strategies and the determination of prognosis for LOGC patients after surgery.…”