Multireader diagnostic performance of MRI-based Node-RADS for pelvic lymph node metastasis in endometrial carcinoma

Objectives To evaluate the efficacy of the MRI-based Node Reporting and Data System (MRI-Node-RADS) in diagnosing pelvic lymph node metastasis (PLNM) in patients with endometrial carcinoma (EC).

EC patients were retrospectively enrolled from July 2017 to August 2024. Two readers evaluated pelvic lymph nodes (PLNs) using MRI-Node-RADS. Pathological results served as the gold standard for determining the diagnostic accuracy of the scores. The criteria across size-based subregions were compared, focusing on obturator lymph nodes (Ob LNs) and non-obturator lymph nodes (non-Ob LNs). Inter-reader agreement was assessed using the weighted kappa statistic (κw). The area under the curve (AUC) was calculated to assess the sensitivity and specificity of the MRI-Node-RADS scores.

Four hundred seventy-five PLNs were evaluated in 174 EC patients, comprising 85 metastatic and 390 non-metastatic PLNs. The inter-reader agreement was near-perfect at both evaluation levels: patient-level analyses (κw = 0.87) and regional analyses across eight pelvic locations (κw = 0.94). An MRI-Node-RADS score of > 2 demonstrated optimal diagnostic performance, with an AUC of 0.93 (91.1% sensitivity, 84.5% specificity) at the patient level and 0.91 (85.9% sensitivity, 91.8% specificity) when analyzing individual PLN regions. The best performance among individual criteria was “Any change in texture” in Ob LNs and “Border: irregular or ill-defined” in non-Ob LNs.

The MRI-Node-RADS effectively diagnoses PLNM, and a score of > 2 may be recommended as the optimal reference value for diagnosing PLNM in EC patients. Key Points Question Accurate assessment of PLNM is crucial for patients with EC, yet standardized guidelines for radiological reports are lacking. Findings An MRI-Node-RADS score of > 2 is identified as the optimal cut-off for diagnosing PLNM, with nearly perfect inter-reader agreement. Clinical relevance MRI-Node-RADS demonstrates excellent performance in diagnosing PLN metastases in patients with EC, suggesting that Node-RADS could be used as a reliable tool for clinical staging and personalized therapeutic decision-making. Graphical Abstract Similar content being viewed by others Abbreviations - ADC: - Apparent diffusion coefficient - AUC: - Area under the curve - DWI: - Diffusion-weighted imaging - EC: - Endometrial carcinoma - ESGO/ESTRO/ESP: - European Society of Gynaecological Oncology (ESGO), the European Society for Therapeutic Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) - IQR: - Interquartile ranges - LNM: - Lymph node metastasis - LNs: - Lymph nodes - MLN: - metastatic lymph node - MRI: - Magnetic resonance imaging - MRI-Node-RADS: - MRI-based node reporting and data system - Node-RADS 1.0: - Node reporting and data system 1.0 - non-Ob LNs: - Non-obturator lymph nodes - NPV: - Negative predictive value - Ob LNs: - Obturator lymph nodes - PLNM: - Pelvic lymph node metastasis - PLNs: - Pelvic lymph nodes - PPV: - Positive predictive value - ROC: - Receiver operating characteristic - κw : - Weighted kappa statistics

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Cancers (Basel) 13:5120. https://doi.org/10.3390/cancers13205120 Funding This study has received funding from the Applied Basic Research Project of Liaoning Province (2022JH2/101300074), the Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute) (LD2023034), which is supported by the Fundamental Research Funds for the Central Universities; and the Joint Tackling Project in Science and Technology of Liaoning Province (2024JH2/102600185). Author information Authors and Affiliations Corresponding author Ethics declarations Guarantor The scientific guarantor of this publication is Yue Dong. Conflict of interest The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry No complex statistical methods were necessary for this paper. Informed consent The requirement for informed consent was waived (retrospective design) by the Institutional Review Board of Liaoning Cancer Hospital & Institute. Ethical approval Institutional Review Board approval was obtained. Study subjects or cohorts overlap Not applicable. Methodology - Retrospective - Diagnostic or prognostic study - Performed at one institution Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Liu, G., Wang, X., Zhao, M. et al. Multireader diagnostic performance of MRI-based Node-RADS for pelvic lymph node metastasis in endometrial carcinoma. Eur Radiol 36, 2730–2741 (2026). https://doi.org/10.1007/s00330-025-12056-4 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00330-025-12056-4