Assessment of inter-expert agreement among ultrasound diagnostic physicians using the Russian classification of lymphatic nodules ultrasound characteristics LN-RADS

In the last decade, much attention has been paid to the development of objective criteria for assessing the results of visualization studies in medicine, allowing to minimize diagnostic errors and facilitate the interaction of doctors of different specialties. To assess the condition of the lymph nodes, a scale for the stratification of ultrasound signs LN-RADS has been proposed.

Purpose: assessment of the reproducibility of the results of using the LN-RADS scale for stratification of ultrasound signs of lymph nodes and assessment of the consistency of decisions of ultrasound diagnostic doctors who used this classification.

Materials and methods. To assess an inter-rater agreement for LN-RADS scale, sixteen  experienced specialists in ultrasound independently assessed fifty ultrasound images of the lymphatic nodes with various benign and malignant changes.

Results. The inter-rater agreement in utilisation of the LN-RADS scale was moderate, reaching a significant level when assessing malignant changes in the lymph nodes.

Conclusions. The LN-RADS stratification system allows for the detection of malignant changes with fairly good reproducibility, which is especially important from a diagnostic point of view.

1. Ryu K.H., Lee K.H., Ryu J. et al. Cervical Lymph Node Imaging Reporting and Data System for Ultrasound of Cervical Lymphadenopathy: A Pilot Study. Am. J. Roentgenol. 2016; 206 (6): 1286–1291. https://doi.org/10.2214/AJR.15.15381

2. Alamdaran S.A., Randian A., Rasoulian B. et al. Correlation of Sonographic Classification of Neck Adenopathy (A-RADS) and Malignancy. Iran. J. Otorhinolaryngol. 2023; 35 (126): 39–47. https://doi.org/10.22038/IJORL.2022.67255.3299

3. Zhang M., Ahn R.W., Hayes J.C. et al. Axillary Lymphadenopathy in the COVID-19 Era: What the Radiologist Needs to Know. Radiographics. 2022; 42 (7): 1897–1911. https://doi.org/10.1148/rg.220045

4. Bedi D.G., Krishnamurthy R., Krishnamurthy S. et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. Am. J. Roentgenol. 2008; 191 (3): 646–652. https://doi.org/10.2214/AJR.07.2460

5. Fisenko E.Р., Allakhverdieva G.F., Danzanova T.Yu. et al. Rationale for creating a new classification for evaluation superficial lymph nodes US NODE-RADS (Russian version) based on ultrasound data: the consensus of experts of the Russian Association of Ultrasound Diagnostics in Medicine. Khirurgiya i onkologiya = Surgery and Oncology. 2024; 14 (3): 11–17. https://doi.org/10.17650/2949-5857-2024-14-3-11-17 (In Russian)

6. The project of the Russian Ultrasound Classification of superficial lymph nodes R-US-Lymph-RADS. Materials of the Russian National Congress of Radiation Diagnosticians and Therapeutists “Radiology – 2024”. May 28–30, 2024, Moscow. MD-Onco. 2024; 4 (4): 20–31. https://doi.org/10.17650/2782-3202-2024-4-4-20-31 (In Russian)

7. Randolph J.J.. Online Kappa Calculator [Computer software]. 2008. Retrieved from http://justus.randolph.name/kappa

8. Feng G.C. Mistakes and how to avoid mistakes in using intercoder reliability indices. Methodology. 2015; 11: 13–22. https://doi.org/10.1027/1614-2241/a000086

9. Fisenko E.P., Allahverdieva G.F., Bulanov M.N. et al. Standardization of the protocol of superficial lymph node ultrasound. Consensus of experts of the Russian association of specialists of ultrasound in medicine (RASUDM). Ultrasound & Functional Diagnostics. 2024; 4: 115–131. https://doi.org/10.24835/1607-0771-294 (In Russian)

10. Fisherova D., Garganese G., Reina H. et al.Terms, definitions and measurements to describe sonographic features of lymph nodes: consensus opinion from the Vulvar International Tumor Analysis (VITA) group. Ultrasound in Obstetrics & Gynecology. 2021; 57 (6): 861–879. https://doi.org/10.1002/uog.23617

11. Vuong H.G., Ngo H.T.T., Bychkov A. et al. Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: a systematic review and meta-analysis. Cancer Cytopathol. 2020; 128: 238–249. https://doi.org/10.1002/cncy.22228