SynthesisEuropean radiology2025
Node-RADS: a systematic review and meta-analysis of diagnostic performance, category-wise malignancy rates, and inter-observer reliability.
Synthesis in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Letter to the Editor: Calibrating Node-RADS thresholds for nodal staging in nasopharyngeal carcinoma.European radiology · 2026Article
- CT-based Node-RADS for metastatic lymph node detection in colon cancer and influence of microsatellite instability.Abdominal radiology (New York) · 2026Article
- Combining Node-RADS with ADC can improve diagnostic performance for lymph node metastasis in breast cancer.European radiology · 2026Article
- Head-to-head pathologic validation of Node-RADS vs size-based criteria for cervical lymph node metastasis in nasopharyngeal carcinoma.European radiology · 2026Article
- Reply to the Letter to the Editor: Calibrating Node-RADS thresholds for nodal staging in nasopharyngeal carcinoma.European radiology · 2026Article
- Reply to the Letter to the Editor: From detecting axillary metastasis to guiding clinically actionable axillary management in breast cancer.European radiology · 2026Article
- CT-based Node-RADS for evaluating regional lymph node metastasis and postoperative recurrence in patients with pancreatic ductal adenocarcinoma undergoing upfront surgery.European radiology · 2026Article
- Assessment of inter-reader agreement and diagnostic performance of Node-RADS in colon cancer.Insights into imaging · 2026Article
- CT-based Node-RADS classification in the assessment of rectal cancer: diagnostic performance and postoperative prognostic stratification.BMC cancer · 2026Article
- MRI Dark-Light-Dark Sign and Node Reporting Score: An Integrated Model for Predicting Lymph Node Metastasis in Rectal Cancer.Journal of clinical medicine · 2026Article
- Prognostic and Diagnostic Value of Node-RADS for Non-Small Cell Lung Cancer Following Neoadjuvant Therapy: A Multicenter Cohort Study.Diagnostics (Basel, Switzerland) · 2026Article
- Node-RADS in cervical cancer: a multi-reader agreement and diagnostic performance study.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Article
- A head-to-head comparison of MRI and CT using Node-RADS for rectal cancer lymph nodes: Observer agreement and diagnostic performance.European journal of radiology open · 2026Article
- Deep Learning-Based Detection of Malignant and Equivocal Cervical Lymph Nodes on CT Imaging Using a 2D U-Net++ Model.Maedica · 2026Article
- Beyond size criteria: Node-RADS improves reliability in MRI-based lymph node classification for endometrial cancer.European radiology · 2026Article
- Lymph Node Assessment with Multiparametric Ultrasound: Normal Values, Morphologic Patterns, and Diagnostic Algorithms.Cancers · 2026Article
- Letter to the Editor: Node-RADS and nodal staging-promise, pitfalls, and pathways forward.European radiology · 2026Article
- An improved diagnostic criterion based on Node-RADS MRI score for lymph node metastasis in papillary thyroid carcinoma.Quantitative imaging in medicine and surgery · 2026Article
- Node-RADS for preoperative locoregional nodal staging of endometrial cancer: reproducibility and accuracy assessment using CT and MRI.European radiology · 2026Article
- Development and validation of MRI-based models to predict lymph node metastasis in bladder cancer: a multi-center study.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Article
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Authors and funding
20 authors.
Funding
Abstract
objectiveTo perform a systematic review and meta-analysis to estimate diagnostic performance, category-wise malignancy rates, and inter-observer reliability of Node Reporting and Data System 1.0 (Node-RADS).
methodsFive electronic databases were systematically searched for primary studies on the use of Node-RADS to report the possibility of cancer involvement of lymph nodes on CT and MRI from January 1, 2021, until April 15, 2024. The study quality was assessed by modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Quality Appraisal of Diagnostic Reliability (QAREL) tools. The diagnostic accuracy was estimated with bivariate random-effects model, while the pooled category-wise malignancy rates were obtained with random-effects model.
resultsSix Node-RADS-CT studies and three Node-RADS-MRI studies covering nine types of cancer were included. The study quality was mainly damaged by inappropriate index test and unknown timing according to QUADAS-2, and unclear blindness during the rating process according to QAREL. The area under hierarchical summary receiver operating characteristic curve (95% conventional interval) was 0.92 (0.89-0.94) for Node-RADS ≥ 3 as positive and 0.91 (0.88-0.93) for Node-RADS ≥ 4 as positive, respectively. The pooled malignancy rates (95% CIs) of Node-RADS 1 to 5 were 4% (0-10%), 31% (9-58%), 55% (34-75%), 89% (73-99%), and 100% (97-100%), respectively. The inter-observer reliability of five studies was interpreted as fair to substantial.
conclusionNode-RADS presented a promising diagnostic performance with an increasing probability of malignancy along higher category. However, the evidence for inter-observer reliability of Node-RADS is insufficient, and may hinder its implementation in clinical practice for lymph node assessment. KEY POINTS: Question Node-RADS is designed for structured reporting of the possibility of cancer involvement of lymph nodes, but the evidence supporting its application has not been summarized. Findings Node-RADS presented diagnostic performance with AUC of 0.92, and malignancy rates for categories 1-5 ranged from 4% to 100%, while the inter-observer reliability was unclear. Clinical relevance Node-RADS is a useful tool for structured reporting of the possibility of cancer involvement of lymph nodes with high diagnostic performance and appropriate malignancy rate for each category, but unclear inter-observer reliability may hinder its implementation in clinical practice.
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