Fang Yu, Chen Ming, Zheng XuFeng, Yao Yubin, Huang Kainan, Chen Silian, Xu Tingting, Xu Zhuangyong, Lin Daiying
Department of Radiology, Shantou Central Hospital, Shantou, 515031, People's Republic of China.
Eur Radiol. 2025 Jun;35(6):2999-3009. doi: 10.1007/s00330-024-11234-0. Epub 2024 Nov 29.
The accurate identification of positive lymph nodes in esophageal squamous cell carcinoma (ESCC) influences patient risk assessment and treatment decisions, but there is no standardized approach for radiological evaluation. The aim of this study was to verify the diagnostic performance of the new Node Reporting and Data System 1.0 (Node-RADS) in the assessment of lymph node metastasis in patients with ESCC, as verified by final histopathology.
Node-RADS is a scoring system composed of different criteria for evaluating lymph node metastasis, with scores ranging from 1 to 5, corresponding to the degree of suspicion of lymph node involvement. In this single-center study, Node-RADS was used to retrospectively evaluate regional lymph nodes in 173 ESCC patients who underwent computed tomography (CT) before radical resection. In addition, the area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the Node-RADS score and individual criteria.
Node-RADS outperformed the individual assessment criteria (AUC: 94.3%, sensitivity: 96.5%, specificity: 92.0%), with scores ≥ 3 indicating the maximum diagnostic effectiveness. The diagnostic efficiency of the highest Node-RADS score surpassed that of the short axis score (AUC: 94.3% vs. 81.9%, p < 0.001). Our results indicated that the best diagnostic cut-off points for the short axis, long axis and short axis/long axis ratio were 9 mm, 11 mm, and 0.74, respectively.
Node-RADS has emerged as a practical, repetitive method for the early identification of high-risk metastatic lymph nodes, providing therapeutic guidance and predicting disease prognosis in ESCC patients.
Question How does the Node Reporting and Data System 1.0 (Node-RADS) perform in the assessment of lymph node metastasis in patients with esophageal squamous cell carcinoma (ESCC)? Findings The maximum diagnostic efficiency was achieved with a Node-RADS score of ≥ 3. Clinical relevance The Node-RADS has improved diagnostic efficiency for distinguishing lymph node metastasis in patients with ESCC.
准确识别食管鳞状细胞癌（ESCC）中的阳性淋巴结对患者风险评估和治疗决策有影响，但目前尚无标准化的放射学评估方法。本研究旨在通过最终组织病理学验证，评估新的淋巴结报告与数据系统1.0（Node-RADS）在ESCC患者淋巴结转移评估中的诊断性能。
Node-RADS是一种评分系统，由评估淋巴结转移的不同标准组成，评分范围为1至5分，对应淋巴结受累的可疑程度。在这项单中心研究中，使用Node-RADS对173例在根治性切除术前接受计算机断层扫描（CT）的ESCC患者的区域淋巴结进行回顾性评估。此外，计算了Node-RADS评分和各个标准的ROC曲线下面积（AUC）、准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
Node-RADS的表现优于个体评估标准（AUC：94.3%，敏感性：96.5%，特异性：92.0%），评分≥3分表明诊断效能最高。最高Node-RADS评分的诊断效率超过了短轴评分（AUC：94.3%对81.9%，p<0.001）。我们的结果表明，短轴、长轴和短轴/长轴比的最佳诊断切点分别为9mm、11mm和0.74。
Node-RADS已成为一种实用、可重复的方法，用于早期识别高危转移性淋巴结，为ESCC患者提供治疗指导并预测疾病预后。
问题：淋巴结报告与数据系统1.0（Node-RADS）在食管鳞状细胞癌（ESCC）患者淋巴结转移评估中的表现如何？发现：Node-RADS评分≥3分时诊断效率最高。临床意义：Node-RADS提高了ESCC患者区分淋巴结转移的诊断效率。
