Applying Node-RADS to breast MRI exams improves staging
Node-RADS scores have shown great utility in predicting lymph node invasion (LNI) in various cancers, but the system’s use in patients with breast cancer has not been thoroughly explored.
However, when experts recently applied the Node-RADS system to more than 1,100 lymph nodes in patients with breast cancer, they found that readers were significantly more accurate at identifying LNI.
“The presence of lymph node metastases is a crucial factor considered by the current cancer treatment guidelines worldwide; any macroscopic lymph-node metastasis indicates at least stage II disease," corresponding author Roberto Maroncelli, with the department of radiological, oncological, and pathological sciences at Sapienza University of Rome, and colleagues note. "Patients with locally advanced BC (stage IB-IIIC), regardless of subtype, are ideal candidates for neoadjuvant chemotherapy. Therefore, a precise evaluation of lymphadenopathies holds significant importance.”
The study included 192 patients who had undergone preoperative contrast-enhanced breast MRI and lymph node dissection between January 2020 and January 2023. Three different readers calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value of different Node-RADS cutoffs.
All three readers saw improvements in specificity and PPV when the Node-RADS cutoff values were increased. Reader 1's specificity improved from 71.4% to 100% and their PPV from 76.7% to 100%; Reader 2's rose from 69.4% to 100% and 74.6% to 100%, and Reader 3's jumped from 64.3% to 100% and 72% to 100%, respectively.
The experts established an ideal cutoff value of Node-RADS > 2, as it yielded the most balance among readers. The authors add that Node-RADS scores of 3, 4 or 5 are "strongly indicative of metastatic disease" and should be considered in disease management.
“The Node-RADS scores revealed a positive trend in the rates of LNI,” the group writes. “Specifically, Node-RADS scores increased the LNI risk, establishing their status as an independent predictor even after adjusting for multiple variables. The linear-by-linear association depicted this relationship, showing a progressive rise in LNI risk with increasing Node-RADS scores.”
The use of Node-RADS also yielded consistent performance across all three readers, even one with less experience in interpreting breast MRI exams. The readers indicated that the system was especially beneficial in doubtful cases when a lack of standard diagnostic guidelines could create confusion, potentially causing patients to have to undergo unnecessary exams to further analyze questionable findings.
“This indicates that the scoring system can effectively aid in identifying suspicious lymph nodes, staging the disease, establishing a standardized language for communicating the presence of such nodes, and avoiding unnecessary biopsies,” the group suggests.
The study abstract is available in European Radiology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.