Background: Current cross-sectional imaging modalities exhibit heterogenous diagnostic performances for the detection of a lymph node invasion (LNI) in bladder cancer (BCa) patients. Recently, the Node-RADS score was introduced to provide a standardized comprehensive evaluation of LNI, based on a five-item Likert scale accounting for both size and configuration criteria. In the current study, we hypothesized that the Node-RADS score accurately predicts the LNI and tested its diagnostic performance. Methods: We retrospectively reviewed BCa patients treated with radical cystectomy (RC) and bilateral extended pelvic lymph node dissection, from January 2019 to June 2022. Patients receiving preoperative systemic chemotherapy were excluded. A logistic regression analysis tested the correlation between the Node-RADS score and LNI both at patient and lymph-node level. The ROC curves and the AUC depicted the overall diagnostic performance. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for different cut-off values (>1, >2, >3, >4). Results: Overall, data from 49 patients were collected. Node-RADS assigned on CT scans images, was found to independently predict the LNI after an adjusted multivariable regression analysis, both at the patient (OR 3.36, 95%CI 1.68-9.40, p = 0.004) and lymph node (OR 5.18, 95%CI 3.39-8.64, p < 0.001) levels. Node-RADS exhibited an AUC of 0.87 and 0.91 at the patient and lymph node levels, respectively. With increasing Node-RADS cut-off values, the specificity and PPV increased from 57.1 to 97.1% and from 48.3 to 83.3%, respectively. Conversely, the sensitivity and NPV decreased from 100 to 35.7% and from 100 to 79.1%, respectively. Similar trends were recorded at the lymph node level. Potentially, Node-RADS > 2 could be considered as the best cut-off value due to balanced values at both the patient (77.1 and 78.6%, respectively) and lymph node levels (82.4 and 93.4%, respectively). Conclusions: The current study lays the foundation for the introduction of Node-RADS for the regional lymph-node evaluation in BCa patients. Interestingly, the Node-RADS score exhibited a moderate-to-high overall accuracy for the identification of LNI, with the possibility of setting different cut-off values according to specific clinical scenarios. However, these results need to be validated on larger cohorts before drawing definitive conclusions.

Performance of Node-RADS scoring system for a standardized assessment of regional lymph nodes in bladder cancer patients / Leonardo, Costantino; Rocco Simone Flammia, ; Lucciola, Sara; Proietti, Flavia; Pecoraro, Martina; Bucca, Bruno; Leslie Claire Licari, ; Borrelli, Antonella; Bologna, Eugenio; Landini, Nicholas; Maurizio Del Monte, ; Chung, Benjamin I.; Catalano, Carlo; Fabio Massimo Magliocca, ; Ettore De Berardinis, ; Del, Giudice; Panebianco, Valeria. - In: CANCERS. - ISSN 2072-6694. - 15:3(2023). [10.3390/cancers15030580]

Performance of Node-RADS scoring system for a standardized assessment of regional lymph nodes in bladder cancer patients

Costantino Leonardo
Co-primo
;
Sara Lucciola;Flavia Proietti;martina pecoraro;Bruno Bucca;Leslie Claire Licari;Antonella Borrelli;Eugenio Bologna;Nicholas Landini;Carlo Catalano;Del Giudice
Penultimo
;
Valeria Panebianco
Ultimo
2023

Abstract

Background: Current cross-sectional imaging modalities exhibit heterogenous diagnostic performances for the detection of a lymph node invasion (LNI) in bladder cancer (BCa) patients. Recently, the Node-RADS score was introduced to provide a standardized comprehensive evaluation of LNI, based on a five-item Likert scale accounting for both size and configuration criteria. In the current study, we hypothesized that the Node-RADS score accurately predicts the LNI and tested its diagnostic performance. Methods: We retrospectively reviewed BCa patients treated with radical cystectomy (RC) and bilateral extended pelvic lymph node dissection, from January 2019 to June 2022. Patients receiving preoperative systemic chemotherapy were excluded. A logistic regression analysis tested the correlation between the Node-RADS score and LNI both at patient and lymph-node level. The ROC curves and the AUC depicted the overall diagnostic performance. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for different cut-off values (>1, >2, >3, >4). Results: Overall, data from 49 patients were collected. Node-RADS assigned on CT scans images, was found to independently predict the LNI after an adjusted multivariable regression analysis, both at the patient (OR 3.36, 95%CI 1.68-9.40, p = 0.004) and lymph node (OR 5.18, 95%CI 3.39-8.64, p < 0.001) levels. Node-RADS exhibited an AUC of 0.87 and 0.91 at the patient and lymph node levels, respectively. With increasing Node-RADS cut-off values, the specificity and PPV increased from 57.1 to 97.1% and from 48.3 to 83.3%, respectively. Conversely, the sensitivity and NPV decreased from 100 to 35.7% and from 100 to 79.1%, respectively. Similar trends were recorded at the lymph node level. Potentially, Node-RADS > 2 could be considered as the best cut-off value due to balanced values at both the patient (77.1 and 78.6%, respectively) and lymph node levels (82.4 and 93.4%, respectively). Conclusions: The current study lays the foundation for the introduction of Node-RADS for the regional lymph-node evaluation in BCa patients. Interestingly, the Node-RADS score exhibited a moderate-to-high overall accuracy for the identification of LNI, with the possibility of setting different cut-off values according to specific clinical scenarios. However, these results need to be validated on larger cohorts before drawing definitive conclusions.
2023
Node-RADS; bladder cancer; bladder cancer staging; lymph-node invasion; radical cystectomy.
01 Pubblicazione su rivista::01a Articolo in rivista
Performance of Node-RADS scoring system for a standardized assessment of regional lymph nodes in bladder cancer patients / Leonardo, Costantino; Rocco Simone Flammia, ; Lucciola, Sara; Proietti, Flavia; Pecoraro, Martina; Bucca, Bruno; Leslie Claire Licari, ; Borrelli, Antonella; Bologna, Eugenio; Landini, Nicholas; Maurizio Del Monte, ; Chung, Benjamin I.; Catalano, Carlo; Fabio Massimo Magliocca, ; Ettore De Berardinis, ; Del, Giudice; Panebianco, Valeria. - In: CANCERS. - ISSN 2072-6694. - 15:3(2023). [10.3390/cancers15030580]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1669235
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