Journal Article

DKFZ-2025-02292

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png The Pelvic Rosetta Classification Project: An Interdisciplinary Proposal for a Lymph Node Map of the Pelvis in Prostate Cancer.

Ortner, G. ; Hoderlein, X. ; Barbato, F.DKFZ* ; Beyersdorff, D. ; Budäus, L. ; Burger, I. A. ; Eiber, M. ; Graefen, M. ; Hadaschik, B.DKFZ* ; Haese, A. ; Herrmann, K.DKFZ* ; Maack, L. ; Maric, I. ; Mattei, A. ; Rauscher, I. ; Salomon, G. ; Sauer, M. ; Schimmöller, L. ; Schlaefer, A. ; Schlemmer, H.-P.DKFZ* ; Spohn, S. K. B.DKFZ* ; Umutlu, L. ; Walz, J. ; Würnschimmel, C. ; Koehler, D. ; Maurer, T.

2026
Soc. New York, NY

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.

Keyword(s): PSA ; lymph node drainage ; metastases ; sentinel ; standardization

Note: 2026 Jan 2;67(1):154-159

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Contributing Institute(s):

1. DKTK Koordinierungsstelle Essen/Düsseldorf (ED01)
2. E010 Radiologie (E010)
3. DKTK Koordinierungsstelle Freiburg (FR01)

Research Program(s):

1. 315 - Bildgebung und Radioonkologie (POF4-315) (POF4-315)

Appears in the scientific report 2025

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; Essential Science Indicators ; IF >= 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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