European radiology · 2025
Node-RADS for preoperative locoregional nodal staging of endometrial cancer: reproducibility and accuracy assessment using CT and MRI.
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Bonatti Matteo, Valletta Riccardo, Corato Valentina, Proner Bernardo, Hoxha Laurjan, Odoferdi Luca, Steinkasserer Martin, Ninkova Roberta Valerieva, Avesani Giacomo, Vingiani Vincenzo, Manganaro Lucia
Аннотация
OBJECTIVES: To assess the reproducibility and diagnostic accuracy of the Node Reporting and Data System 1.0 (Node-RADS) for detecting pelvic nodal metastases by endometrial cancer (EC) using CT and MRI, among readers with different levels of expertise.
MATERIALS AND METHODS: This IRB-approved, single-center retrospective study included 128 patients with EC who underwent preoperative MRI at our Institution (Jan 2020-Dec 2023). Six readers with different levels of expertise in pelvic MRI (2 dedicated pelvic radiologists, 2 residents in their fourth year of training, and 2 residents in their second year of training) independently evaluated preoperative CTs and MRIs and assigned Node-RADS scores. Inter-observer agreement and inter-method agreement were calculated. Node-RADS was compared with post-surgical pathology data.
RESULTS: At surgery, pelvic nodal metastases were detected in 12.5% of the patients. Interobserver agreement in nodal status assessment using Node-RADS varied from κ = 0.783 to κ = 0.426 using MRI, and from κ = 0.936 to κ = 0.295 using CT, with worse results among less experienced readers. MRI and CT were concordant in the N definition in 94-98% of the cases. Using MRI, the most experienced readers showed 63% sensitivity and 100% specificity in the detection of nodal metastases, compared to 44% sensitivity and 96% specificity for poorly experienced readers. Using CT, the most experienced readers showed 50% sensitivity and 100% specificity; the less experienced readers showed 43% sensitivity and 94% specificity.
CONCLUSIONS: Node-RADS is a reproducible and accurate tool for locoregional nodal staging of EC, but only for readers with specific experience in pelvic imaging. MRI outperforms CT in nodal assessment.
KEY POINTS: Question Preoperative assessment of nodal metastases by EC is difficult, but it may help in tailoring the best surgical approach for each patient. Findings Node-RADS is a reliable tool for assessing the presence of pelvic nodal metastases by EC, both on CT and MRI, among experienced readers. Clinical relevance The use of Node-RADS among experienced readers enables detection of nodal metastases with good sensitivity and excellent specificity; MRI should be preferred over CT due to its higher sensitivity.
MATERIALS AND METHODS: This IRB-approved, single-center retrospective study included 128 patients with EC who underwent preoperative MRI at our Institution (Jan 2020-Dec 2023). Six readers with different levels of expertise in pelvic MRI (2 dedicated pelvic radiologists, 2 residents in their fourth year of training, and 2 residents in their second year of training) independently evaluated preoperative CTs and MRIs and assigned Node-RADS scores. Inter-observer agreement and inter-method agreement were calculated. Node-RADS was compared with post-surgical pathology data.
RESULTS: At surgery, pelvic nodal metastases were detected in 12.5% of the patients. Interobserver agreement in nodal status assessment using Node-RADS varied from κ = 0.783 to κ = 0.426 using MRI, and from κ = 0.936 to κ = 0.295 using CT, with worse results among less experienced readers. MRI and CT were concordant in the N definition in 94-98% of the cases. Using MRI, the most experienced readers showed 63% sensitivity and 100% specificity in the detection of nodal metastases, compared to 44% sensitivity and 96% specificity for poorly experienced readers. Using CT, the most experienced readers showed 50% sensitivity and 100% specificity; the less experienced readers showed 43% sensitivity and 94% specificity.
CONCLUSIONS: Node-RADS is a reproducible and accurate tool for locoregional nodal staging of EC, but only for readers with specific experience in pelvic imaging. MRI outperforms CT in nodal assessment.
KEY POINTS: Question Preoperative assessment of nodal metastases by EC is difficult, but it may help in tailoring the best surgical approach for each patient. Findings Node-RADS is a reliable tool for assessing the presence of pelvic nodal metastases by EC, both on CT and MRI, among experienced readers. Clinical relevance The use of Node-RADS among experienced readers enables detection of nodal metastases with good sensitivity and excellent specificity; MRI should be preferred over CT due to its higher sensitivity.