Introducing Node RADS: Concept of Standardized Assessment of Lymphnodes

• 12 Jul 2021 10:22:05 AM
• |General Urology

Dear all,

As all Urological Cancers have Lymphnodular Mets associated, their presence or absence will have considerable changes in adoption of treatments offered. Hence this new Node RADS system being introduced will have considerable influence on the way we deal with reporting of Lymphnode metastases.  

The Node Reporting and Data System 1.0 (Node-RADS) standardizes reporting of possible cancer involvement of regional and distant lymph nodes on CT and MR imaging. Node-RADS is applicable at any anatomical site, proposing the use in the scoring of the categories of “size” and “configuration” for assigning the 5-point Node-RADS assessment category score. An increase in the consensus of radiologic assessment of lymph nodes will facilitate uniformity of primary tumour staging, and evaluation of response to treatment.

• Node-RADS proposes the scoring categories “size” and “configuration” for assigning the 5-point Node-RADS score from 1

(“very low likelihood”) to 5 (“very high likelihood”).

• Node-RADS aims to increase consensus among radiologists for primary staging and in response assessment settings.

The evaluation of a lymph node using the Node-RADS scheme results in an assessment category scored between 1 and 5, which reflects the level of suspicion for involvement by malignancy: 1-'very low’; 2-‘low’; 3-'equivocal’; ‘4- high’; 5-'very high.”

In general, a lymph node is defined to have a ‘normal’ size, when its short-axis diameter is < 10 mm. Node-RADS defines exceptions for normal size for inguinal nodes which could measure < 15 mm in short-axis diameter; on the other hand, Node-RADS sets a lower cut off for specific subregions (like Obturator). A ‘bulk’ is defined as a lymph node with the longest diameter of ≥ 30 mm measured in any dimension.

As this is the 1.0 version with this being introduced newly, it is possible that more versions could emerge to facilitate more accurate assessment.

It has to be reiterated that Node RADS is not organ specific. Efforts are on to make them more specific for organs in future and we will have to wait for that. No doubt this is a step forward in decision of treatments that could be offered.

With warm regards,

Venu

 

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