Node-RADS: a systematic review and meta-analysis of diagnostic performance, category-wise malignancy rates, and...

Area of Science:

• Radiology
• Oncology
• Diagnostic Accuracy

Background:

• Structured reporting systems are crucial for consistent lymph node assessment.
• The Node Reporting and Data System 1.0 (Node-RADS) aims to standardize the evaluation of lymph node cancer involvement.
• Evidence on the diagnostic performance and reliability of Node-RADS requires comprehensive summarization.

Purpose of the Study:

• To systematically review and meta-analyze the diagnostic performance of Node-RADS.
• To estimate category-wise malignancy rates for Node-RADS.
• To assess the inter-observer reliability of Node-RADS in CT and MRI lymph node assessment.

Main Methods:

• Systematic search of five electronic databases (Jan 2021-Apr 2024).
• Inclusion of primary studies on Node-RADS for lymph node cancer assessment.
• Quality appraisal using QUADAS-2 and QAREL tools; diagnostic accuracy estimated with bivariate random-effects model.

Main Results:

• Included six Node-RADS-CT and three Node-RADS-MRI studies covering nine cancer types.
• Area under the curve (AUC) for Node-RADS ≥3 was 0.92 and for Node-RADS ≥4 was 0.91.
• Pooled malignancy rates for Node-RADS categories 1-5 ranged from 4% to 100%; inter-observer reliability was fair to substantial.

Conclusions:

• Node-RADS demonstrates promising diagnostic performance with increasing malignancy probability across categories.
• The system shows high diagnostic accuracy (AUC 0.92) and clear malignancy rates per category.
• Insufficient evidence on inter-observer reliability may impede widespread clinical implementation of Node-RADS.