Performance of Node-RADS Scoring System for a Standardized Assessment of Regional Lymph Nodes in Bladder Cancer Patients

Abstract

Background: Current cross-sectional imaging modalities exhibit heterogenous diagnostic performances for the detection of a lymph node invasion (LNI) in bladder cancer (BCa) patients. Recently, the Node-RADS score was introduced to provide a standardized comprehensive evaluation of LNI, based on a five-item Likert scale accounting for both size and configuration criteria. In the current study, we hypothesized that the Node-RADS score accurately predicts the LNI and tested its diagnostic performance. Methods: We retrospectively reviewed BCa patients treated with radical cystectomy (RC) and bilateral extended pelvic lymph node dissection, from January 2019 to June 2022. Patients receiving preoperative systemic chemotherapy were excluded. A logistic regression analysis tested the correlation between the Node-RADS score and LNI both at patient and lymph-node level. The ROC curves and the AUC depicted the overall diagnostic performance. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for different cut-off values (>1, >2, >3, >4). Results: Overall, data from 49 patients were collected. Node-RADS assigned on CT scans images, was found to independently predict the LNI after an adjusted multivariable regression analysis, both at the patient (OR 3.36, 95%CI 1.68–9.40, p = 0.004) and lymph node (OR 5.18, 95%CI 3.39–8.64, p < 0.001) levels. Node-RADS exhibited an AUC of 0.87 and 0.91 at the patient and lymph node levels, respectively. With increasing Node-RADS cut-off values, the specificity and PPV increased from 57.1 to 97.1% and from 48.3 to 83.3%, respectively. Conversely, the sensitivity and NPV decreased from 100 to 35.7% and from 100 to 79.1%, respectively. Similar trends were recorded at the lymph node level. Potentially, Node-RADS > 2 could be considered as the best cut-off value due to balanced values at both the patient (77.1 and 78.6%, respectively) and lymph node levels (82.4 and 93.4%, respectively). Conclusions: The current study lays the foundation for the introduction of Node-RADS for the regional lymph-node evaluation in BCa patients. Interestingly, the Node-RADS score exhibited a moderate-to-high overall accuracy for the identification of LNI, with the possibility of setting different cut-off values according to specific clinical scenarios. However, these results need to be validated on larger cohorts before drawing definitive conclusions.

Diagnostic Performance of Node Reporting and Data System Magnetic Resonance Imaging Score in Detecting Metastatic Cervical Lymph Nodes of Nasopharyngeal Carcinoma

“…However, Node-RADS achieved a high AUC of 0.94 in diagnosing lung cancer lymph node metastasis 11 and a high AUC of 0.91 in bladder cancer. 12 Our research showed more outstanding diagnostic performance in NPC, providing new possibilities for the extensive application of Node-RADS.…”

“…Node-RADS has shown encouraging diagnostic performance in prostate, lung, and bladder cancer since it launched in 2021. 10 - 12 However, no previous report has explored its role in NPC. We assumed that higher Node-RADS scores are correlated with a higher risk of CLN metastasis.…”

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

“…The authors found an increased specificity (1.00 vs. 0.08–0.19), while sensitivity decreased (0.17 vs. 0.96–1.00) and AUROC remained unchanged (0.58 vs. 0.57–0.60, respectively) compared to validated nomograms [ 23 ]. Leonardo et al investigated the performance of Node-RADS in bladder cancer and demonstrated a moderate-to-high overall accuracy for malignant lymph node invasion with an AUROC of up to 0.91, and the option of setting different cut-off values according to specific clinical scenarios [ 24 ]. Meyer et al assessed lung cancer patients using Node-RADS and radiomics [ 25 ].…”

Impacts of Neoadjuvant Chemotherapy on Perioperative Outcomes in Patients with Bladder Cancer Treated with Radical Cystectomy: A Single High-Volume Center Experience

“…Indeed, the presence of muscle invasion represents an unfavorable prognostic indicator. Despite advances in imaging diagnostics [4,5], a portion of patients already harbors micrometastases at the time of diagnosis [6,7].…”