Background and objectives
The Reporting and Data System (RADS) have been used in the attempts to standardize the results of oncological scans in different scenarios, such as lymph nodes, adding configuration criteria to size determination. We analyze the predictive value of preoperative Node-RADS determination at imaging for pelvic lymph node (PLN) involvement in cases of prostate cancer (PC) considered for radical prostatectomy (RP) with extended lymph node dissection (eLND) and we compare it with validate predictive nomograms (MSKCC, Briganti and Gandaglia).
150 patients with a histological diagnosis of PC (high risk or intermediate with an estimated risk for pN+ higher than 5% using the Briganti or 7% using the Gandaglia nomogram) submitted for RP with an ePLND from 2018 and 2021 were retrospectively examined. Node-RADS determination was performed in all cases using the preoperative magnetic resonance (MR), performed by a radiologist blinded for pathologic results and compared with the MSKCC, Briganti 2012, Gandaglia 2017 and Gandaglia 2019 nomograms.
PLN involvement at final pathology (pN+) was found in 36/150 (24.0%) of cases and the mean percentage of positive LNs in pN+ cases was 15.90 ± 13.40. The mean number of PLNs removed at RP was similar (p = 0.188) between pN0 (23.9 ± 8.0) and pN+ (25.3 ± 8.0) cases. Considering a Node RADS 4–5 positive and a Node RADS 1–2 negative, the PPV was 100% and the NPV was 79.6%. A Node RADS score 4–5 showed a lower sensitivity (0.167 versus 0.972, 1.000, 0.971, 0.960 respectively), a higher specificity (1.000 versus 0.079, 0.096, 0.138, 0.186 respectively) and a similar AUC (0.583 versus 0.591, 0.581, 0.574, 0.597 respectively) when compared to MSKCC, Briganti 2012, Gandaglia 2017 and Gandaglia 2019 nomograms.
Our evaluation suggests that Node RADS score, combining configuration criteria to size determination could improve specificity in terms of pathologic PLN prediction but a very low sensitivity has been also described.
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Sciarra A, Voria G, Monti S, Mazzone L, Mariotti G, Pozza M, et al. Clinical understaging in patients with prostate adenocarcinoma submitted to radical prostatectomy: predictive value of serum chromogranin A. Prostate 2004;58:421–8.
Mottet N, van den Bergh RCN: Prostate Cancer: European Association of Urology (EAU) guidelines 2021. https://uroweb.org/guideline/prostate-cancer/
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol. 2012;61:480.
Gandaglia G, Fosati N, Zaffuto E, Bandini M, Dell’Oglio P, Bravi CA, et al. Development and internal validation of a novel model to identify the candidates for extended pelvic lymph node dissection in prostate cancer. Eur Urol. 2017;72:632.
Fossati N, Willemse PM, Van den Broeck T, van den Bergh RCN, Yuan CY, Briers E, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol. 2017;72:84.
Lestingi JFP, Guglielmetti GB, Trinh QD, Coelho RF, Pontes J Jr, Bastos DA, et al. Extended versus limited pelvic lymph node dissection during radical prostatectomy for intermediate- and high-risk prostate cancer: early oncological outcomes from a randomized phase 3 trial. Eur Urol. 2021;79:595–604.
Gandaglia G, Ploussard G, Valerio M, Mattei A, Fiori C, Fossati N, et al. A novel nomogram to identify candidates for extended pelvic lymph node dissection among patients with clinically localized prostate cancer diagnosed with magnetic resonance imaging-targeted and systematic biopsies. Eur Urol. 2019;75:506.
Milonas D, Venclovas Z, Muilwijk T, Jievaltas M, Joniau S. External validation of MSKCC nomogram and prediction of optimal candidate for lymph node dissection in clinically localized prostate cancer: Cetral Eur. J Urol. 2020;73:25.
Brown G, Richards CJ, Bourne MW. Morphologic predictors of lymph node status in reactal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227:371–377.
Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ. Comparison of CT and MR imaging in staging of neck metastases. Radiology. 1998;207:123–130.
D’Orsi CJ, Kopans DB. Mammography interpretation: the BI-RADS method. Am Fam Phys. 1997;55:1548–1552.
Elsholtz FHJ, Asbach P, Haas M, Becker M, Beets-tan RGH, Thoeny HC, et al. Introducing the node reporting and Data System 1.0 (Node RADS): a concept for standardized assessment of lymph nodes in cancer. Eur Radio. 2021;31:6116–6124.
Venclovas Z, Muilwijk T, Matjosaitis A, Jievaltas M, Joniau S, Milonas D. Head-to-head comparison of two nomograms predicting probability of lymph node invasion in prostate cancer and the therapeutic impact of higher nomogram threshold. J Clin Med. 2021;10-1:11.
Gandaglia G, Martini A, Ploussard G, Fossati N, Stabile A, De, et al. External validation of th 2019 Briganti nomogram for the identification of prostate cancer patients who should be considered for an extended pelvic lymph node dissection. Eur Urol. 2020;78:138–142.
Fossati N, Willemse PP, Van den Broeck T, van den Bergh RCN, Yuan CY, Mottet N, et al. The benefit and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. Eur Urol. 2017;72:84–109.
Thoeny H, Barbieri S, Froehlich J, Tukhey B, Choyke P. Functional and targeted lymph node imaging in prostate cancer. Radiology. 2017;285:728–742.
Meijer D, van Leeuwen PJ, Roberts MJ, Siriwardana AR, Morton A, Yaxley JW, et al. External validation and addition of prostate specific membrane antigen positron emission tomography to the most frequently used nomograms for the prediction of pelvic lymph node metastases: an international multicenter study. Eur Urol. 2021;80:234–242.
Washington SL 3rd, Cowan JE, Herlemann A, Zuniga KB, Masic S, Nguyen HG, et al. Influence of pelvic lymph node dissection and node-positive diseaseon biochemical recurrence, secondary treatment, and survival after radicalprostatectomy in men with prostate cancer. Prostate 2021;81:102–108.
Touijer KA, Sjoberg DD, Benfante N, Laudone VP, Ehdaie B, Eastham JA, et al. Limited versus Extended Pelvic Lymph Node Dissection for Prostate Cancer: A Randomized Clinical Trial. Eur Urol Oncol. 2021;4:532–539.
Sciarra A, Panebianco V, Salciccia S, Cattarino S, Lisi D, Gentilucci A, et al. Modern role of magnetic resonance and spectroscopy in the imaging of prostate cancer. Urol Oncol. 2011;29:12–20.
Bass EJ, Pantovic A, Connor M, Gabe R, Padhani AR, Rockall A, et al. A systematic review and meta-analysis of the diagnostic accuracy of biparametric prostate MRI for prostate cancer in men at risk. Prostate Cancer Prostatic Dis. 2021;24:596–611.
Hovels A, Heesakkers R, Adang E, Jager G, Trum S. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radio. 2008;63:387–95.
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Lucciola, S., Pisciotti, M.L., Frisenda, M. et al. Predictive role of node-rads score in patients with prostate cancer candidates for radical prostatectomy with extended lymph node dissection: comparative analysis with validated nomograms. Prostate Cancer Prostatic Dis (2022). https://doi.org/10.1038/s41391-022-00564-z