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Abstract

Background

Better selection of patients with intermediate and high-risk stage I endometrial carcinoma (EC) for lymphadenectomy has an important effect on the prognosis.

Purpose

To investigate the role of apparent diffusion coefficient (ADC) measurements in the assessment of stage I EC patients based on three risk categories.

Material and Methods

We retrospectively studied 80 patients with EC and 28 cervical cancer patients with normal endometrium. 1.5-T conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) (b = 0, 1000 s/mm²) were performed, and ADC values were calculated. Sixty-eight stage I EC patients were divided into three groups: low-risk EC (group 1); intermediate-risk EC (group 2); and high-risk EC (group 3). The remaining 12 EC patients were in stages II and III. Intraclass coefficient, Mann–Whitney U test, Kruskal–Wallis test, and receiver operating characteristics were used for statistical analysis.

Results

The mean ADC values ( × 10^–3 mm² /s) were 0.851 ± 0.131, 0.734 ± 0.108, and 0.710 ± 0.108 for groups 1, 2 and 3, respectively. Significant statistical differences were achieved for the three groups (P = 0.0005). The mean ADC values of group 1 were significantly lower than those in group 2 + 3 (0.725 ± 0.106; P = 0.0001). For the prediction of groups 2 + 3, the area under the curve of 0.786 and the cut-off value of ≤ 0.742 were identified, with a sensitivity, specificity, and accuracy of 66.67%, 84.09%, and 73.53%, respectively.

Conclusion

ADC measurements may have the potential to select intermediate-risk and high-risk stage I EC patients for lymphadenectomy.

Keywords

Endometrial carcinoma magnetic resonance imaging diffusion-weighted imaging apparent diffusion coefficient lymphadenectomy risk categorization

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References

Amant

Moerman

Neven

et al.

Endometrial cancer. Lancet 2005; 366: 491–505.

McAlpine

Temkin

Mackay

. Endometrial cancer: not your grandmother’s cancer. Cancer 2016; 122: 2787–2798.

Pecorelli

. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 2009; 105: 103–104.

McMeekin

Lashbrook

Gold

et al.

Nodal distribution and its significance in FIGO stage IIIc endometrial cancer. Gynecol Oncol 2001; 82: 375–379.

Colombo

Preti

Landoni

et al.

Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 26: 35–39.

Boronow

Morrow

Creasman

et al.

Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 1984; 63: 825–832.

Bernadini

May

Khalifa

et al.

Evaluation of two management strategies for preoperative grade I endometrial cancer. Obstet Gynecol 2009; 114: 7–15.

Meissnitzer

Forstner

. MRI of endometrium cancer - how we do it. Cancer Imaging 2016; 16: 11–19.

Colombo

Creutzberg

Amant

et al.

ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol 2016; 27: 16–41.

10.

Patterson

Padhani

Collins

. Technology insight: water diffusion MRI - a potential new biomarker of response to cancer therapy. Nat Clin Pract Oncol 2008; 5: 220–233.

11.

Karakas

Dogan

et al.

Diffusion-weighted MRI in the differential diagnosis of uterine endometrial cavity tumors. Wien Klin Wochenschr 2015; 127: 266–273.

12.

Bakir

Sanli

Bakir

et al.

Role of diffusion weighted MRI in the differential diagnosis of endometrial cancer, polyp, hyperplasia, and physiological thickening. Clin Imaging 2017; 26: 86–94.

13.

Fujii

Matsusue

Kigawa

et al.

Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign and malignant uterine endometrial cavity lesions: initial results. Eur Radiol 2008; 18: 384–389.

14.

Takeuchi

Matsuzaki

Nishitani

. Diffusion-weighted magnetic resonance imaging of endometrial cancer: differentiation from benign endometrial lesions and preoperative assessment of myometrial invasion. Acta Radiol 2009; 50: 947–953.

15.

Kilickesmez

Bayramoglu

Inci

et al.

Quantitative diffusion-weighted magnetic resonance imaging of normal and diseased uterine zones. Acta Radiol 2009; 50: 340–347.

16.

Kierans

Bennett

Haghighi

et al.

Utility of conventional and diffusion-weighted MRI features in distinguishing benign from malignant endometrial lesions. Eur J Radiol 2014; 83: 726–732.

17.

Tamai

Koyama

Saga

et al.

Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 2007; 26: 682–687.

18.

Beddy

Moyle

Kataoka

et al.

Evaluation of depth of myometrial invasion and overall staging in endometrial cancer: comparison of diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology 2012; 262: 530–537.

19.

Husby

Salvesen

Magnussen

et al.

Tumour apparent diffusion coefficient is associated with depth of myometrial invasion and is negatively correlated to tumour volume in endometrial carcinomas. Clin Radiol 2015; 70: 487–494.

20.

Jiang

Zhao

Zhang

et al.

Endometrial carcinoma: diffusion-weighted imaging diagnostic accuracy and correlation with Ki-67 expression. Clin Radiol 2018; 73: 413.e1–413.e6.

21.

Bharwani

Miquel

Sahdev

et al.

Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer. Br J Radiol 2011; 84: 997–1004.

22.

Lee

Dubinsky

Javitt

et al.

ACR appropriateness criteria pretreatment evaluation and follow-up of endometrial cancer of the uterus. Ultrasound Q 2011; 27: 139–145.

23.

Das

Niu

Wang

et al.

Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis. Cancer Imaging 2014; 14: 32–42.

24.

Benedetti Panici

Basile

Maneschi

et al.

Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008; 100: 1707–1716.

25.

ASTEC study

group

Kitchener

Swart

et al.

Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009; 373: 125–136.

26.

Vargas

Rauh-Hain

Clemmer

et al.

Tumor size, depth of invasion, and histologic grade as prognostic factors of lymph node involvement in endometrial cancer: a SEER analysis. Gynecol Oncol 2014; 133: 216–220.

27.

Todo

Kato

Kaneuchi

et al.

Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 2010; 375: 1165–1172.

28.

Kishimotol

Tajima

Maeda

et al.

Endometrial cancer: correlation of apparent diffusion coefficient (ADC) with tumor cellularity and tumor grade. Acta Radiol 2015; 45: 1021–1028.

29.

Sivridis

Giatromanolaki

Anastasiadis

et al.

Angiogenic co-operation of VEGF and stromal cell TP in endometrial carcinomas. J Pathol 2002; 196: 416–422.

30.

Inoue

Fujii

Kaneda

et al.

Apparent diffusion coefficient (ADC) measurement in endometrial carcinoma: effect of region of interest methods on ADC values. J Magn Reson Imaging 2014; 40: 157–161.

31.

Woo

Cho

Kim

. Histogram analysis of apparent diffusion coefficient map of diffusion-weighted MRI in endometrial cancer: a preliminary correlation study with histological grade. Acta Radiol 2014; 55: 1270–1277.

The ability of ADC measurements in the assessment of patients with stage I endometrial carcinoma based on three risk categories

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

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References