The Pelvic Rosetta Classification (PRC) project aimed to develop an interdisciplinary, landmark-based pelvic lymph node map for patients with prostate cancer to improve communication between imaging specialists and urologists.
Methods: After an intense development phase, we conducted 3 evaluation rounds including 19 clinical experts having consensus meetings after each evaluation round. Experts contoured lymph node areas (LNA) for 2 patients with prostate cancer. Contours were assessed qualitatively and quantitatively. The PRC was further validated by assignment of 30 prostate-specific membrane antigen PET/CT-positive lesions to LNAs. The interrater reliability was calculated using Fleiss κ. Based on the final PRC, a complete contour and a 3-dimensional model were created. Results: Eight pelvic (external iliac, cranial/caudal obturator fossa, dorsal internal iliac, vesico-prostatic pedicle, mesorectal/perirectal, presacral, preprostatic/retropubic) and 4 extrapelvic (common iliac, intercommon, sigmoid, inguinal) LNAs were defined using anatomic landmarks which are consistently recognizable on imaging and intraoperatively. Strong consensus between experts existed for smaller, well-defined LNAs (e.g., preprostatic/retropubic, mesorectal/perirectal LNAs) compared with regions with proportionally large borders (e.g., obturator fossa, vesico-prostatic pedicle LNAs). Overall, moderate agreement (κ = 0.53) was observed during validation. Discrepancies were mostly encountered for lesions adjacent to borders between LNAs. The final contour and 3-dimensional model were approved by all experts. Conclusion: The PRC project showed fair reproducibility and validity. Further external validation is needed to assess its influence on interdisciplinary communication and treatment outcomes.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2025 Nov 06 [Epub ahead of print]
Gernot Ortner, Xenia Hoderlein, Francesco Barbato, Dirk Beyersdorff, Lars Budäus, Irene A Burger, Matthias Eiber, Markus Graefen, Boris Hadaschik, Alexander Haese, Ken Herrmann, Lennart Maack, Ines Maric, Agostino Mattei, Isabel Rauscher, Georg Salomon, Markus Sauer, Lars Schimmöller, Alexander Schlaefer, Heinz-Peter Schlemmer, Simon K B Spohn, Lale Umutlu, Jochen Walz, Christoph Würnschimmel, Daniel Koehler, Tobias Maurer
Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Nuclear Medicine, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany., Department of Nuclear Medicine, Cantonal Hospital Baden, Affiliated Hospital for Research and Teaching of the Faculty of Medicine of the University of Zurich, Baden, Switzerland., School of Medicine, Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany and Bavarian Center for Cancer Research, Munich, Germany., Department of Urology, German Cancer Consortium-University Hospital Essen, University of Duisburg-Essen, Essen, Germany., Institute of Medical Technology and Intelligent Systems, Hamburg University of Technology, Hamburg, Germany., Department of Urology, Cantonal Hospital of Lucerne, Lucerne, Switzerland., Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany, and Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Dusseldorf, Germany., Division of Radiology, German Cancer Research Center, Heidelberg, Germany., Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, and German Cancer Consortium, partner site Freiburg, Freiburg, Germany., Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; and., EAU Section of Imaging, European Association of Urology, Hamburg, Germany., Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41198239