The Pelvic Rosetta Classification Project: An Interdisciplinary Proposal for a Lymph Node Map of the Pelvis in Prostate Cancer
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. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusion:</b> The PRC project showed fair reproducibility and validity. Further external validation is needed to assess its influence on interdisciplinary communication and treatment outcomes.
Authors
- Markus Graefen
- Ken Herrmann (ORCID: https://orcid.org/0000-0002-9662-7259)
- Lennart Maack (ORCID: https://orcid.org/0009-0002-0097-0157)
- Christoph Würnschimmel (ORCID: https://orcid.org/0000-0001-7891-4791)
- Simon K. B. Spohn (ORCID: https://orcid.org/0000-0003-2727-8005)
- Daniel Köehler (ORCID: https://orcid.org/0000-0003-2940-7050)
- Jochen Walz (ORCID: https://orcid.org/0000-0002-1379-7608)
- Tobias Maurer (ORCID: https://orcid.org/0000-0002-5660-7691)
- Gernot Ortner (ORCID: https://orcid.org/0000-0002-2454-6599)
- Irene A. Burger (ORCID: https://orcid.org/0000-0001-8029-8692)
- Lale Umutlu (ORCID: https://orcid.org/0000-0001-5215-7171)
- Isabel Rauscher (ORCID: https://orcid.org/0000-0003-4655-2153)
- Matthias Eiber (ORCID: https://orcid.org/0000-0003-2130-644X)
- Agostino Mattei (ORCID: https://orcid.org/0000-0002-5110-4796)
- Boris Hadaschik (ORCID: https://orcid.org/0000-0002-1052-2692)
- Dirk Beyersdorff
- Lars Budäus
- Ines Maríc
- Alexander Schlaefer (ORCID: https://orcid.org/0000-0001-9201-8854)
- Lars Schimmöller (ORCID: https://orcid.org/0000-0001-7476-292X)
- Alexander Haese (ORCID: https://orcid.org/0000-0001-9339-9521)
- Markus Sauer (ORCID: https://orcid.org/0000-0002-4174-0959)
- Francesco Barbato (ORCID: https://orcid.org/0000-0003-4642-6827)
- Heinz-Peter Schlemmer
- Georg Salomon
- Xenia Hoderlein
Institutions
- Universität Hamburg (DE)
- University of Lucerne (CH)
- German Cancer Research Center (DE)
- Heidelberg University (DE)
- European Association of Urology (NL)
- University Medical Center Freiburg (DE)
- TUM Klinikum (DE)
- Universitätsklinik Marien Hospital Herne (DE)
- Düsseldorf University Hospital (DE)
- University Medical Center Hamburg-Eppendorf (DE)
- Martini-Klinik (DE)
- Essen University Hospital (DE)
- Kantonsspital Baden (CH)
- Marien Hospital Düsseldorf (DE)
- Centre de Recherche en Cancérologie de Marseille (FR)
- Institut Paoli-Calmettes (FR)
- West German Heart and Vascular Center Essen (DE)
- Heinrich Heine University Düsseldorf (DE)
- University of Duisburg-Essen (DE)
- Hamburg University of Technology (DE)
Publication Details
- Journal
- Journal of Nuclear Medicine
- Published
- 2025-11-06
- DOI
- https://doi.org/10.2967/jnumed.125.270667
- Primary Topic
- Prostate Cancer Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00