The Pelvic Rosetta Classification Project: An Interdisciplinary Proposal for a Lymph Node Map of the Pelvis in Prostate Cancer
Year: 2025
Type: article
Abstract: 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.
Source: Journal of Nuclear Medicine
Authors: 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
Institutions: University Medical Center Hamburg-Eppendorf, Martini-Klinik, University of Duisburg-Essen, European Association of Urology, University of Zurich, Kantonsspital Baden, TUM Klinikum, Technical University of Munich, Essen University Hospital, Hamburg University of Technology, Luzerner Kantonsspital, University Hospitals of the Ruhr-University of Bochum, Universitätsklinik Marien Hospital Herne, Düsseldorf University Hospital, Heinrich Heine University Düsseldorf, German Cancer Research Center, University of Freiburg, University Medical Center Freiburg, Institut Paoli-Calmettes
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4415966346