{"paper_id":"2737931b-bf0f-44fd-bc45-963a9bcd8241","body_text":"Abstract\nObjectives\nTo 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).\nMaterials and methods\nEC 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.\nResult\nFour 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.\nConclusion\nThe 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.\nKey Points\nQuestion Accurate assessment of PLNM is crucial for patients with EC, yet standardized guidelines for radiological reports are lacking.\nFindings An MRI-Node-RADS score of > 2 is identified as the optimal cut-off for diagnosing PLNM, with nearly perfect inter-reader agreement.\nClinical 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.\nGraphical Abstract\nSimilar content being viewed by others\nAbbreviations\n- ADC:\n-\nApparent diffusion coefficient\n- AUC:\n-\nArea under the curve\n- DWI:\n-\nDiffusion-weighted imaging\n- EC:\n-\nEndometrial carcinoma\n- ESGO/ESTRO/ESP:\n-\nEuropean Society of Gynaecological Oncology (ESGO), the European Society for Therapeutic Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP)\n- IQR:\n-\nInterquartile ranges\n- LNM:\n-\nLymph node metastasis\n- LNs:\n-\nLymph nodes\n- MLN:\n-\nmetastatic lymph node\n- MRI:\n-\nMagnetic resonance imaging\n- MRI-Node-RADS:\n-\nMRI-based node reporting and data system\n- Node-RADS 1.0:\n-\nNode reporting and data system 1.0\n- non-Ob LNs:\n-\nNon-obturator lymph nodes\n- NPV:\n-\nNegative predictive value\n- Ob LNs:\n-\nObturator lymph nodes\n- PLNM:\n-\nPelvic lymph node metastasis\n- PLNs:\n-\nPelvic lymph nodes\n- PPV:\n-\nPositive predictive value\n- ROC:\n-\nReceiver operating characteristic\n- κw :\n-\nWeighted kappa statistics\nReferences\nBray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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Cancers (Basel) 13:5120. https://doi.org/10.3390/cancers13205120\nFunding\nThis 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).\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nGuarantor\nThe scientific guarantor of this publication is Yue Dong.\nConflict of interest\nThe authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.\nStatistics and biometry\nNo complex statistical methods were necessary for this paper.\nInformed consent\nThe requirement for informed consent was waived (retrospective design) by the Institutional Review Board of Liaoning Cancer Hospital & Institute.\nEthical approval\nInstitutional Review Board approval was obtained.\nStudy subjects or cohorts overlap\nNot applicable.\nMethodology\n-\nRetrospective\n-\nDiagnostic or prognostic study\n-\nPerformed at one institution\nAdditional information\nPublisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary information\nRights and permissions\nSpringer 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.\nAbout this article\nCite this article\nLiu, 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\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00330-025-12056-4","source_license":"CC0","license_restricted":false}