ultrasound-based node-rads: introducing a new scoring system for ultrasound-based classification of lymphadenopathy

Introduction: lymphadenopathy often causes anxiety due to its association with malignancy or serious infections. this study investigates the role of ultrasound features in distinguishing benign from malignant neck lymphadenopathy and proposes a quantitative scoring system (node-rads).materials and methods: this cross-sectional study was conducted at omid hospital, mashhad university of medical sciences, iran. seven hundred ninety-one patients with neck lymphadenopathy underwent gray-scale and doppler ultrasound, followed by fine needle aspiration (fna) or core needle biopsy (cnb) for cytopathological confirmation. key ultrasound features assessed included short-axis diameter (sad), cortical/hilar echotexture, and vascular patterns. a scoring system was developed by assigning malignancy coefficients to each variable. malignancy coefficients (wi) were assigned based on the prevalence of malignancy for each feature, and a quantitative node-rads score was derived. diagnostic accuracy was evaluated using roc analysis. results:of 791 patients, 68.5% (542) had malignant lymphadenopathy, predominantly metastases (57.1%, 452). malignancy coefficients (wi = 9) were extracted to high-risk features: sad >16 mm (82% malignancy), isoechoic cortex with compressed hilum (89%), and non-hilar vascularity (91%). the proposed node-rads system achieved an auc of 0.85 (95% ci: 0.817–0.889), demonstrating strong diagnostic performance.conclusion: the proposed ultrasound-based node-rads scoring system correlates significantly with pathologic results, offering an appropriate tool for evaluating cervical superficial lymphadenopathy.