With LN-RADS innovative approach, we are transforming the way lymph nodes are diagnosed. Using multiparametric, morfological criteria we can detect very small macrometastes - even 2-3mm leasions. In comparison to traditional 10mm SAD size criteria LN-RADS can find more over 20% of metastatic lymph nodes. The heuristic model of assessment makes it very quick. The simplicity of LN-RADS allows for better communication between radiologist and clinicians. LN-RADS can be used in US, CT, MR, PET.
Lymph nodes are crucial in the diagnosis and treatment of cancer. The LNRADS system itself critically changes the quality of lymph node assessment and, thanks to the support of artificial intelligence, it achieves an even higher level of compliance of the assessment with histopathological results. AI solutions support both radiologists and oncologists in their daily work and it can be an effective tool for education in this area.
LN-RADS 1 normal LN
No enlargement (recommended max SAD up to 6-7mm), oval shape (L/S-ratio > 2), regular cortex max thickness ≤3mm, cortex echogenicity similar or higher to the background fatty tissue, smooth margins, no others changes in architecture (no calcifications, no fluid collections, no necrosis, no FCT), no pathological peripheral or chaotic vascularization
LN-RADS 2 steatotic LN
LNs enlarged in one or both axes, cortex regular, max thickness ≤3mm, hilum hyperechoic (steatotic) with no size limits, no other changes in architecture (no calcifications, no fluid collections, no necrosis, no FCT), no pathological peripheral or chaotic vascularization)
LN-RADS 3 reactive LN
Probably due to inflammatory process or vaccination. Dominant feature: regular, thickened cortex >3mm, enlargement in one or two axes, preserved oval shape (L/S-ratio > 2), preserved medulla, no others changes in architecture (no calcifications, no fluid collections, no necrosis, no FCT), cortex echogenicity similar or moderately lower to the background fatty tissue, well defined margins, no pathologic peripheral or chaotic vascularization, no oncological, hematological history, no laboratory oncological abnormalities
LN-RADS 4 suspicious LN
4a low, 4b high probability of malignancy. This group is dedicated to LNs that morphologically don’t match to group 1, 2, 3, 5 or have additional radiological or clinical factors increasing probability of malignancy in LNs categorized as LN-RADS 3 i.e. high or increasing laboratory markers (i.e. PSA for inguinal LNs), active neoplasm in the region (i.e. breast cancer for axillary LNs), another metastatic or systemic LNs in the region, clinical symptoms suggesting oncological or systemic hematological disease. The main rule of selecting LNs to group 4 is that “better check than miss” .
LN-RADS 4a low suspicious for malignancy – size may be normal in SAD and LAD, cortex with thickenning ≤4mm, moderate irregularity especially local. In assumption all LN 4a should be verified in biopsy or PET, if it is not possible they should be treated as suspected and malignant.
LN-RADS 4b high suspicious of malignancy – size may be normal in SAD and LAD, cortex thickening >4mm and irregularity, especially FCT, or no hilum, shape more round than oval (L/S-ratio≤2), hypoechogenicity to background fatty tissue especially “black hole sign”, micro-calcifications, fluid collections, necrosis, abnormal peripheral or chaotic vascularization architecture, ill-defined blurred margin
LN-RADS 5 malignant LN
Enlargement in SAD and one or more malignancy features: lack of hilum, hypoechogenicity to the background fatty tissue or “black hole sign”, evident cortex irregularity /FCT,” shape more round than oval (L/S-ratio≤2), micro-calcifications, fluid collections, necrosis, abnormal peripheral or chaotic vascularization architecture, ill defined, blurred borders or sign of extracapsular infiltration.
If strong radiological and clinical features of malignancy are present, enlargement is not neccessary to classification to LN-RADS 5
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The basics of the LN-RADS - video lecture
There is a real need for the creation and implementation of a simple tool for better communication between radiologists, clinicians and pathologists concerning lymph node (LN) assessment; particularly giving a clear signal and describing risk of cancer involvement.The LN-RADS scoring system, universal for any diagnostic modality (e.g., US, CT, MRI), realizes the idea of simplifying it lymph node classification.