基于 CT 的 Node Reporting and Data System（Node-RADS）在评估直肠癌中直肠系膜淋巴结方面的诊断性能。

Diagnostic performance of Node Reporting and Data System (Node-RADS) for assessing mesorectal lymph node in rectal cancer by CT.

机构信息

Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China.

Department of Diagnostic Radiology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.

出版信息

BMC Cancer. 2024 Jun 11;24(1):716. doi: 10.1186/s12885-024-12487-0.

DOI:10.1186/s12885-024-12487-0

PMID:38862951

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11165899/

Abstract

BACKGROUND

To compare the diagnostic performance of the Node-RADS scoring system and lymph node (LN) size in preoperative LN assessment for rectal cancer (RC), and to investigate whether the selection of size as the primary criterion whereas morphology as the secondary criterion for LNs can be considered the preferred method for clinical assessment.

METHODS

Preoperative CT data of 146 RC patients treated with radical resection surgery were retrospectively analyzed. The Node-RADS score and short-axis diameter of size-prioritized LNs and the morphology-prioritized LNs were obtained. The correlations of Node-RADS score to the pN stage, LNM number and lymph node ratio (LNR) were investigated. The performances on assessing pathological lymph node metastasis were compared between Node-RADS score and short-axis diameter. A nomogram combined the Node-RADS score and clinical features was also evaluated.

RESULTS

Node-RADS score showed significant correlation with pN stage, LNM number and LNR (Node-RADS of size-prioritized LN: r = 0.600, 0.592, and 0.606; Node-RADS of morphology-prioritized LN: r = 0.547, 0.538, and 0.527; Node-RADSmax: r = 0.612, 0.604, and 0.610; all p < 0.001). For size-prioritized LN, Node-RADS achieved an AUC of 0.826, significantly superior to short-axis diameter (0.826 vs. 0.743, p = 0.009). For morphology-prioritized LN, Node-RADS exhibited an AUC of 0.758, slightly better than short-axis diameter (0.758 vs. 0.718, p = 0.098). The Node-RADS score of size-prioritized LN was significantly better than that of morphology-prioritized LN (0.826 vs. 0.758, p = 0.038). The nomogram achieved the best diagnostic performance (AUC = 0.861) than all the other assessment methods (p < 0.05).

CONCLUSIONS

The Node-RADS scoring system outperforms the short-axis diameter in predicting lymph node metastasis in RC. Size-prioritized LN demonstrates superior predictive efficacy compared to morphology-prioritized LN. The nomogram combined the Node-RADS score of size-prioritized LN with clinical features exhibits the best diagnostic performance. Moreover, a clear relationship was demonstrated between the Node-RADS score and the quantity-dependent pathological characteristics of LNM.

摘要

背景

本研究旨在比较 Node-RADS 评分系统和淋巴结（LN）大小在直肠癌（RC）术前 LN 评估中的诊断性能，并探讨以大小作为 LN 形态学的主要标准作为临床评估的首选方法是否合理。

方法

回顾性分析了 146 例接受根治性切除术治疗的 RC 患者的术前 CT 数据。获取了 Node-RADS 评分、大小优先 LN 的短轴直径和形态优先 LN 的短轴直径。分析了 Node-RADS 评分与 pN 分期、LN 转移数和淋巴结比值（LNR）的相关性。比较了 Node-RADS 评分和短轴直径对评估病理性淋巴结转移的性能。还评估了结合 Node-RADS 评分和临床特征的列线图。

结果

Node-RADS 评分与 pN 分期、LN 转移数和 LNR 显著相关（大小优先 LN 的 Node-RADS：r=0.600、0.592 和 0.606；形态优先 LN 的 Node-RADS：r=0.547、0.538 和 0.527；Node-RADSmax：r=0.612、0.604 和 0.610；均 p<0.001）。对于大小优先 LN，Node-RADS 的 AUC 为 0.826，明显优于短轴直径（0.826 与 0.743，p=0.009）。对于形态优先 LN，Node-RADS 的 AUC 为 0.758，略优于短轴直径（0.758 与 0.718，p=0.098）。大小优先 LN 的 Node-RADS 评分明显优于形态优先 LN（0.826 与 0.758，p=0.038）。列线图的诊断性能（AUC=0.861）优于其他所有评估方法（p<0.05）。

结论

在预测 RC 淋巴结转移方面，Node-RADS 评分系统优于短轴直径。大小优先 LN 比形态优先 LN 具有更好的预测效能。结合大小优先 LN 的 Node-RADS 评分和临床特征的列线图具有最佳的诊断性能。此外，还证实了 Node-RADS 评分与 LNM 数量依赖性病理特征之间存在明确的关系。