淋巴结影像报告和数据系统（Node-Rads）评分在拟行根治性前列腺切除术并扩大淋巴结清扫术的前列腺癌患者中的预测作用：与验证后的列线图的对比分析
Predictive role of node-rads score in patients with prostate cancer candidates for radical prostatectomy with extended lymph node dissection: comparative analysis with validated nomograms.
作者信息
Lucciola Sara, Pisciotti Martina Lucia, Frisenda Marco, Magliocca Fabio, Gentilucci Alessandro, Del Giudice Francesco, Canale Vittorio, Scarrone Emiliano, Busetto Gian Maria, Carrieri Giuseppe, Cormio Luigi, Carbone Antonio, Pastore Antonio, De Nunzio Cosimo, Tubaro Andrea, Leonardo Costantino, Franco Giorgio, Di Pierro Giovanni Battista, Salciccia Stefano, Sciarra Alessandro, Panebianco Valeria
机构信息
Department of Radiologic Sciences, University Sapienza of Rome, Rome, Italy.
Department of Urology, University Sapienza, Rome, Italy.
出版信息
Prostate Cancer Prostatic Dis. 2023 Jun;26(2):379-387. doi: 10.1038/s41391-022-00564-z. Epub 2022 Jun 22.
BACKGROUND AND OBJECTIVES
The Reporting and Data System (RADS) have been used in the attempts to standardize the results of oncological scans in different scenarios, such as lymph nodes, adding configuration criteria to size determination. We analyze the predictive value of preoperative Node-RADS determination at imaging for pelvic lymph node (PLN) involvement in cases of prostate cancer (PC) considered for radical prostatectomy (RP) with extended lymph node dissection (eLND) and we compare it with validate predictive nomograms (MSKCC, Briganti and Gandaglia).
METHODS
150 patients with a histological diagnosis of PC (high risk or intermediate with an estimated risk for pN+ higher than 5% using the Briganti or 7% using the Gandaglia nomogram) submitted for RP with an ePLND from 2018 and 2021 were retrospectively examined. Node-RADS determination was performed in all cases using the preoperative magnetic resonance (MR), performed by a radiologist blinded for pathologic results and compared with the MSKCC, Briganti 2012, Gandaglia 2017 and Gandaglia 2019 nomograms.
RESULTS
PLN involvement at final pathology (pN+) was found in 36/150 (24.0%) of cases and the mean percentage of positive LNs in pN+ cases was 15.90 ± 13.40. The mean number of PLNs removed at RP was similar (p = 0.188) between pN0 (23.9 ± 8.0) and pN+ (25.3 ± 8.0) cases. Considering a Node RADS 4-5 positive and a Node RADS 1-2 negative, the PPV was 100% and the NPV was 79.6%. A Node RADS score 4-5 showed a lower sensitivity (0.167 versus 0.972, 1.000, 0.971, 0.960 respectively), a higher specificity (1.000 versus 0.079, 0.096, 0.138, 0.186 respectively) and a similar AUC (0.583 versus 0.591, 0.581, 0.574, 0.597 respectively) when compared to MSKCC, Briganti 2012, Gandaglia 2017 and Gandaglia 2019 nomograms.
CONCLUSIONS
Our evaluation suggests that Node RADS score, combining configuration criteria to size determination could improve specificity in terms of pathologic PLN prediction but a very low sensitivity has been also described.
背景与目的
报告与数据系统（RADS）已被用于尝试在不同场景下规范肿瘤扫描结果，如淋巴结，在大小判定的基础上增加了形态学标准。我们分析了术前淋巴结RADS判定对考虑行根治性前列腺切除术（RP）并扩大淋巴结清扫术（eLND）的前列腺癌（PC）患者盆腔淋巴结（PLN）受累情况的预测价值，并将其与经过验证的预测列线图（纪念斯隆凯特琳癌症中心[MSKCC]、布里甘蒂和甘达利亚列线图）进行比较。
方法
回顾性研究了2018年至2021年期间150例经组织学诊断为PC（高危或中危，使用布里甘蒂列线图估计pN+风险高于5%或使用甘达利亚列线图估计高于7%）并接受ePLND的RP患者。所有病例均使用术前磁共振成像（MR）进行淋巴结RADS判定，由对病理结果不知情的放射科医生操作，并与MSKCC、2012年布里甘蒂、2017年甘达利亚和2019年甘达利亚列线图进行比较。
结果
150例病例中有36例（24.0%）最终病理显示PLN受累（pN+），pN+病例中阳性淋巴结的平均百分比为15.90±13.40。RP时pN0（23.9±8.0）和pN+（25.3±8.0）病例切除的PLN平均数量相似（p = 0.188）。若淋巴结RADS为4 - 5阳性且淋巴结RADS为1 - 2阴性，则阳性预测值（PPV）为100%，阴性预测值（NPV）为79.6%。与MSKCC、2年布里甘蒂、2017年甘达利亚和2019年甘达利亚列线图相比，淋巴结RADS评分为4 - 5时敏感性较低（分别为0.167对0.972、1.000、0.971、0.960），特异性较高（分别为1.000对0.079、0.096、0.138、0.186），曲线下面积（AUC）相似（分别为0.583对0.591、0.581、0.574、0.597）。
结论
我们的评估表明，结合形态学标准与大小判定得出的淋巴结RADS评分在病理PLN预测方面可提高特异性，但也发现其敏感性非常低。
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