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Published on: April 18, 2025
CT-based Node-RADS for standardized evaluation of lymph node metastasis in rectal cancer and its clinicopathological
Xiaoyi Xiao1, Fei Jiang1, You Chen1
1Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Minde Road, Nanchang, China; Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging, Nanchang, Jiangxi, China.
Background:
Lymph node metastasis identification has important clinical implications for treatment decision-making in rectal cancer (RC). To evaluate the diagnostic performance of the CT-based Node Reporting and Data System 1.0 (Node-RADS) for lymph node metastasis risk in treatment-naive RC patients, and to investigate the correlation between the Node-RADS score and clinicopathological factors.
Methods:
A single-center retrospective study was performed to RC patients (Aug 2020-Dec 2025) who underwent radical resection surgery and preoperative contrast-enhanced CT examination. Lymph node status was assessed using Node-RADS score ranging from 1 to 5. Sensitivity, specificity, and Youden's index were calculated for different Node-RADS cut-off values. The overall diagnostic performance was evaluated using receiver operating characteristic curves and the area under the curve (AUC). The associations between Node-RADS score and clinicopathological parameters were analyzed.
Results:
A total of 459 RC patients were evaluated, including 174 pN + and 285 pN-. Node-RADS scores ≥ 3 and ≥ 4 have the satisfactory diagnostic performance, with sensitivity/ specificity/Youden's index of 87.36 %/58.25 %/0.46 for Node-RADS scores ≥ 3 by Reader 1, 89.08 %/54.04 %/0.43 for Node-RADS scores ≥ 3 by Reader 2, 74.14 %/78.95 %/0.53 for Node-RADS scores ≥ 4 by Reader 1, and 72.99 %/75.44 %/0.48 for Node-RADS scores ≥ 4 by Reader 2, respectively. The AUC of Node-RADS scores were 0.831(95 %CI:0.793-0.864) and 0.806(95 %CI:0.767-0.841) by Reader 1 and Reader 2, respectively. Node-RADS score correlated with pathological T stage, N stage, and lymphovascular invasion. The inter-reader agreement for Node-RADS score were substantial, with weighted kappa values of 0.650.
Conclusions:
The CT-based Node-RADS demonstrates stability and satisfactory diagnostic performance for identifying patients with lymph node metastasis in treatment-naive RC.
