The Node Reporting and Data System (Node-RADS) for standardized MRI evaluation of lymph nodes in endometrial cancer, integrated with clinicopathological and molecular data

To evaluate the diagnostic performance of Node-RADS score using magnetic resonance imaging (MRI) in predicting lymph node involvement (LNI) in patients with endometrial cancer (EC). Additionally, the applicability of the Node-RADS score was evaluated by three readers with different levels of experience in pelvic imaging. Finally, this study investigated the correlation between the Node-RADS score and the extent of myometrial invasion, histological type, lympho vascular invasion (LVI) and molecular subtype. Out of 108 cases, 82 patients with histologically confirmed locally advanced EC met the inclusion criteria for retrospective analysis. LNI risk was assessed for each pelvic lymph node station using a Node-RADS score (1-5). Diagnostic accuracy was determined by comparing scores to histologic findings, considered as the gold standard. Three independent readers with different experience levels assigned scores. The Node-RADS score strongly correlated with histologically confirmed LNI (AUC: 0.832). A cutoff of Node-RADS ≥ 3 optimally detected metastatic lymph nodes, with 85.71 % sensitivity and 76.47 % specificity. Interobserver agreement was high, with κ values of 0.86 (senior vs. junior reader 1) and 0.70 (senior vs. junior reader 2). A significant positive correlation was found between Node-RADS score and myometrial invasion as well as LVI. Node-RADS score is a reliable, standardized tool for assessing LN stations and enhancing diagnostic accuracy in locoregional staging of EC.