Journal Article

Diagnostic utility of apparent diffusion coefficient in preoperative assessment of endometrial cancer: are we ready for the 2023 FIGO staging?

Saleh, Gehad A., Hassan, Amany, Hamdy, Omar, Tantawy, Mohammed Salah Ibrahim, Abdelrazek, Rasha

2024

Overview

Background Although endometrial cancer (EC) is staged surgically, magnetic resonance imaging (MRI) plays a critical role in assessing and selecting the most appropriate treatment planning. We aimed to assess the diagnostic performance of quantitative analysis of diffusion-weighted imaging (DWI) in preoperative assessment of EC. Methods Prospective analysis was done for sixty-eight patients with pathology-proven endometrial cancer who underwent MRI and DWI. Apparent diffusion coefficient (ADC) values were measured by two independent radiologists and compared with the postoperative pathological results. Results There was excellent inter-observer reliability in measuring ADCmean values. There were statistically significant lower ADCmean values in patients with deep myometrial invasion (MI), cervical stromal invasion (CSI), type II EC, and lympho-vascular space involvement (LVSI) (AUC = 0.717, 0.816, 0.999, and 0.735 respectively) with optimal cut-off values of ≤ 0.84, ≤ 0.84, ≤ 0.78 and ≤ 0.82 mm 2 /s respectively. Also, there was a statistically significant negative correlation between ADC values and the updated 2023 FIGO stage and tumor grade (strong association), and the 2009 FIGO stage (medium association). Conclusions The preoperative ADCmean values of EC were significantly correlated with main prognostic factors including depth of MI, CSI, EC type, grade, nodal involvement, and LVSI.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Aged, 80 and over / Agreements / Apparent diffusion coefficient / Cancer / Comparative analysis / Diagnostic imaging / Diagnostic systems / Diffusion coefficient / Diffusion Magnetic Resonance Imaging - methods / Diffusion weighted MRI / Drunk driving / Endometrial cancer / Endometrial Neoplasms - diagnostic imaging / Endometrial Neoplasms - pathology / Endometrial Neoplasms - surgery / Endometrium / Female / Gynecological cancer / Humans / Imaging / Magnetic resonance imaging / Medical diagnosis / Medical imaging / Medical imaging equipment / Medical prognosis / Medicine / Medicine & Public Health / Middle Aged / Myometrial invasion / Myometrium / Neoplasm Invasiveness / Neoplasm Staging / Observer Variation / Ovaries / Patients / Preoperative Care - methods / Prospective Studies / Radiology / Reproducibility of Results / Software / Statistical analysis / Surgery / Tumor staging / Tumors / Uterine cancer / Work stations