Eur Radiol. 2025 Aug 20. doi: 10.1007/s00330-025-11923-4. Online ahead of print.
ABSTRACT
OBJECTIVES: To assess the reproducibility and diagnostic accuracy of the Node Reporting and Data System 1.0 (Node-RADS) for detecting pelvic nodal metastases by endometrial cancer (EC) using CT and MRI, among readers with different levels of expertise.
MATERIALS AND METHODS: This IRB-approved, single-center retrospective study included 128 patients with EC who underwent preoperative MRI at our Institution (Jan 2020-Dec 2023). Six readers with different levels of expertise in pelvic MRI (2 dedicated pelvic radiologists, 2 residents in their fourth year of training, and 2 residents in their second year of training) independently evaluated preoperative CTs and MRIs and assigned Node-RADS scores. Inter-observer agreement and inter-method agreement were calculated. Node-RADS was compared with post-surgical pathology data.
RESULTS: At surgery, pelvic nodal metastases were detected in 12.5% of the patients. Interobserver agreement in nodal status assessment using Node-RADS varied from κ = 0.783 to κ = 0.426 using MRI, and from κ = 0.936 to κ = 0.295 using CT, with worse results among less experienced readers. MRI and CT were concordant in the N definition in 94-98% of the cases. Using MRI, the most experienced readers showed 63% sensitivity and 100% specificity in the detection of nodal metastases, compared to 44% sensitivity and 96% specificity for poorly experienced readers. Using CT, the most experienced readers showed 50% sensitivity and 100% specificity; the less experienced readers showed 43% sensitivity and 94% specificity.
CONCLUSIONS: Node-RADS is a reproducible and accurate tool for locoregional nodal staging of EC, but only for readers with specific experience in pelvic imaging. MRI outperforms CT in nodal assessment.
KEY POINTS: Question Preoperative assessment of nodal metastases by EC is difficult, but it may help in tailoring the best surgical approach for each patient. Findings Node-RADS is a reliable tool for assessing the presence of pelvic nodal metastases by EC, both on CT and MRI, among experienced readers. Clinical relevance The use of Node-RADS among experienced readers enables detection of nodal metastases with good sensitivity and excellent specificity; MRI should be preferred over CT due to its higher sensitivity.
PMID:40836021 | DOI:10.1007/s00330-025-11923-4
