Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
Department of Surgery, Parkklinik Weißensee, Schönstraße 80, 13086, Berlin, Germany.
Eur Radiol. 2024 May;34(5):3183-3193. doi: 10.1007/s00330-023-10352-5. Epub 2023 Oct 24.
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.
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.
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).
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.
The results of this study suggest that Node-RADS may be a suitable tool for structured reporting of regional lymph nodes in gastric cancer.
• 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.
在胃癌中，用于区域淋巴结评估的影像学诊断性能仍然有限，并且对于影像学评估缺乏共识。同时，由于需要使用报告和数据系统（RADS）进行标准化的肿瘤成像，因此对结构报告的需求也在不断增加。本研究旨在调查 Node-RADS 与使用各种单独的标准相比，在使用组织病理学作为参考评估胃癌区域淋巴结时的诊断性能。
这是一项回顾性单中心研究，共纳入了 91 名经 CT 扫描和组织学证实为胃腺癌的连续患者（中位年龄 66 岁，范围 33-91 岁，54 名男性），使用 Node-RADS 对区域淋巴结转移的可能性进行评分，从 1 分到 5 分。此外，还分别评估了不同的 Node-RADS 标准以及边界轮廓改变（分叶状、毛刺状、不清晰）的亚类。计算了 Node-RADS 评分和所有研究标准的敏感性、特异性和 Youden 指数。使用 Cohen's kappa 计算了读者间的一致性。
在所有标准中，Node-RADS 评分≥3 和≥4 的性能最佳，敏感性/特异性/Youden 指数分别为 56.8%/90.7%/0.48 和 48.6%/98.1%/0.47，两者均具有显著的读者间一致性（κ=0.73 和 0.67，p<0.01）。在单个标准中，短轴直径 10mm 的性能最佳，敏感性/特异性/Youden 指数分别为 56.8%/87.0%/0.44（κ=0.65，p<0.01）。
本研究表明，与单独使用短轴直径等单个标准相比，在胃癌中对区域淋巴结的大小和形态综合标准进行结构化报告可略微提高整体诊断性能。结果显示特异性提高，敏感性不变。
本研究结果表明，Node-RADS 可能是一种用于胃癌区域淋巴结结构化报告的合适工具。
评估胃癌中的淋巴结仍然有限，并且对于影像学评估缺乏共识。
Node-RADS 可提高整体诊断性能，与包括短轴直径在内的单个标准相比。
Node-RADS 可能是胃癌区域淋巴结结构化报告的合适工具。
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