Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
Department of Maternal and Child Health and Urological Sciences, Oncological and Pathological Sciences, Sapienza, University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
Radiol Med. 2024 Jul;129(7):1062-1075. doi: 10.1007/s11547-024-01824-9. Epub 2024 May 10.
To evaluate the diagnostic accuracy of the Node-RADS score and the utility of apparent diffusion coefficient (ADC) values in predicting metastatic lymph nodes (LNs) involvement in cervical cancer (CC) patients using magnetic resonance imaging (MRI). The applicability of the Node RADS score across three readers with different years of experience in pelvic imaging was also assessed.
Among 140 patients, 68 underwent staging MRI, neoadjuvant chemotherapy and radical surgery, forming the study cohort. Node-RADS scores of the main pelvic stations were retrospectively determined to assess LN metastatic likelihood and compared with the histological findings. Mean ADC, relative ADC (rADC), and correct ADC (cADC) values of LNs classified as Node-RADS ≥ 3 were measured and compared with histological reports, considered as gold standard.
Sensitivity, specificity, positive and negative predictive values (PPVs and NPVs), and accuracy were calculated for different Node-RADS thresholds. Node RADS ≥ 3 showed a sensitivity of 92.8% and specificity of 72.5%. Node RADS ≥ 4 yielded a sensitivity of 71.4% and specificity of 100%, while Node RADS 5 yielded 42.9% and 100%, respectively. The diagnostic performance of mean ADC, cADC and rADC values from 78 LNs with Node-RADS score ≥ 3 was assessed, with ADC demonstrating the highest area under the curve (AUC 0.820), compared to cADC and rADC values.
The Node-RADS score provides a standardized LNs assessment, enhancing diagnostic accuracy in CC patients. Its ease of use and high inter-observer concordance support its clinical utility. ADC measurement of LNs shows promise as an additional tool for optimizing patient diagnostic evaluation.
使用磁共振成像（MRI）评估 Node-RADS 评分对宫颈癌（CC）患者转移性淋巴结（LNs）的诊断准确性，以及表观扩散系数（ADC）值在预测 LN 转移中的作用。还评估了三位在盆腔成像方面经验不同的读者对 Node-RADS 评分的适用性。
在 140 名患者中，有 68 名患者进行了分期 MRI、新辅助化疗和根治性手术，形成了研究队列。回顾性确定主要盆腔站的 Node-RADS 评分，以评估 LN 转移的可能性，并与组织学发现进行比较。对分类为 Node-RADS≥3 的 LN 测量平均 ADC、相对 ADC（rADC）和校正 ADC（cADC）值，并与作为金标准的组织学报告进行比较。
计算了不同 Node-RADS 阈值的敏感性、特异性、阳性和阴性预测值（PPV 和 NPV）和准确性。Node-RADS≥3 的敏感性为 92.8%，特异性为 72.5%。Node-RADS≥4 的敏感性为 71.4%，特异性为 100%，而 Node-RADS 5 的敏感性为 42.9%，特异性为 100%。评估了 78 个具有 Node-RADS 评分≥3 的 LN 的平均 ADC、cADC 和 rADC 值的诊断性能，ADC 的曲线下面积（AUC）最高（0.820），高于 cADC 和 rADC 值。
Node-RADS 评分提供了一种标准化的 LN 评估方法，提高了 CC 患者的诊断准确性。其易于使用和高观察者间一致性支持其临床实用性。LN 的 ADC 测量显示出作为优化患者诊断评估的附加工具的潜力。
