Jiang Li, Zhuang Zijian, Tang Xi, Zhang Fugang, Zhu Haitao, Xu Xuewen, Wang Dongqing, Zhang Lirong
Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu Province, 212001, China.
School of Medicine, Jiangsu University, Zhenjiang, Jiangsu Province, 212001, China.
J Cancer Res Clin Oncol. 2025 Apr 19;151(4):145. doi: 10.1007/s00432-025-06196-9.
To evaluate how well the Node Reporting and Data System (Node-RADS) diagnoses lymph node involvement (LNI) in the initial stages of rectal cancer, utilizing contrast-enhanced CT (CE-CT), T2-weighted MRI (T2WI) and contrast-enhanced T1-weighted MRI (T1CE).
This retrospective study included 113 rectal cancer patients who underwent radical surgery without neoadjuvant therapy. Two radiologists independently assessed regional lymph nodes using the highest NODE-RADS classification and histopathology as reference criteria. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Statistical analysis was performed using the McNemar test with Bonferroni correction for multiple comparisons.
Node-RADS showed improved diagnostic performance over short-axis diameter (SAD) in all modalities (AUC: 0.838 vs. 0.744 for CE-CT, 0.845 vs. 0.747 for T2WI, 0.853 vs. 0.786 for T1CE; all P < 0.05). The sensitivity and specificity of Node-RADS across three modalities ranged from 76.19 - 78.57% and 91.55 - 92.96%, respectively. Pairwise comparisons of sensitivity and specificity among the three modalities showed no significant differences after Bonferroni correction (all McNemar test P = 1.0). There was no significant difference in Node-RADS performance among the three modalities (all P > 0.05). The weighted kappa values were 0.742-0.798.
Node-RADS demonstrated superior diagnostic performance over SAD measurements and similar diagnostic effectiveness in assessing LNI for primary rectal cancer stages across CE-CT, T2WI, and T1CE.
利用对比增强CT（CE-CT）、T2加权磁共振成像（T2WI）和对比增强T1加权磁共振成像（T1CE），评估淋巴结报告与数据系统（Node-RADS）在直肠癌初始阶段对淋巴结受累（LNI）的诊断效果。
这项回顾性研究纳入了113例未接受新辅助治疗而行根治性手术的直肠癌患者。两名放射科医生使用最高的Node-RADS分类独立评估区域淋巴结，并以组织病理学作为参考标准。使用受试者操作特征（ROC）曲线分析评估诊断性能。采用McNemar检验并进行Bonferroni校正以进行多重比较，进行统计学分析。
在所有检查方式中，Node-RADS的诊断性能均优于短轴直径（SAD）（CE-CT的AUC：0.838对0.744，T2WI的AUC：0.845对0.747，T1CE的AUC：0.853对0.786；所有P<0.05）。三种检查方式下Node-RADS的敏感性和特异性分别为76.19%-78.57%和91.55%-92.96%。经Bonferroni校正后，三种检查方式之间敏感性和特异性的两两比较均无显著差异（所有McNemar检验P=1.0）。三种检查方式下Node-RADS的性能无显著差异（所有P>0.05）。加权kappa值为0.742-0.798。
在评估原发性直肠癌各阶段的LNI方面，Node-RADS表现出优于SAD测量的诊断性能，且在CE-CT、T2WI和T1CE检查中具有相似的诊断效果。
