The assessment of the Node Reporting and Data System (Node-RADS) in patients with cervical carcinoma
The assessment of the Node Reporting and Data System (Node-RADS) in patients with cervical carcinoma
Valentina Miceli, Roberta Ninkova, Marco Gennarini, Angelica Cupertino, Federica Curti, Carlo Catalano, Lucia Manganaro.
In 2018 FIGO revised the staging system of cervical carcinoma (cc) emphasizing the lymph node involvement (LNI), configured in stage IIIC. Recently Node-Rads has been introduced to provide a standardized assessment system for LNI based on 5 point scale. In our study, we have hypothesized that the Node-RADS score could accurately predict LNI in patients with cc, by correlating the results with histological data. The secondary objective focuses on assessing the applicability of the score among readers.
From 2014 to 2023, 140 patients were taken care of our Department and underwent clinical examination, multiple biopsies, neoadjuvant chemotherapy and lymphadenectomy surgery. All patients performed MRI prior to treatment. Two readers, blinded to histopathological data, retrospectively classified lymph nodes (LN) according to the MRI node-RADS scoring system. The assigned scored was compared to the actual involvement of neoplasia on a statistical basis. Secondly three different readers have separately assigned a score for all LN detected by MRI.
Overall data from 65 patients were collected. Retrospectively, the analysis was performed on the MRI images, by considering the main LN stations and dividing them into right and left station by assigning a NODE-RADS score for each. 397 lymph nodes were classified as NODE-RADS 1 , 42 as NODE-RADS 2, 34 as NODE RADS 3 , 25 as NODE-RADS 4 and 14 as NODE-RADS 5. By considering a Node-RADS 4–5 positive and a Node-RADS 1–2 negative, the PPV was 100% and the NPV was 80%. A crucial point was the NODE RADS 3 subgroup. Specifically of 34 LN classified as NODE-RADS 3,24 were subclassified as low risk and 10 were overclassified as high-risk, comparing with the anatomical-pathological data. Excellent inter-reader agreement was found.
Our study demonstrates the prognostic potential of NODE-RADS MRI score for radiological standardization of LN in cc.