Utility of diffusion-weighted imaging in association with pathologic upgrading in biopsy-proven grade I endometrial cancer

J Magn Reson Imaging. 2020 Jan;51(1):117-123. doi: 10.1002/jmri.26840. Epub 2019 Jun 17.

Abstract

Background: Prediction of pathologic upgrading is clinically meaningful to identify the optimal candidate of fertility-preserving hormonal treatment in the young patients with biopsy-proven grade I endometrial cancer.

Purpose: To investigate the utility of diffusion-weighted imaging (DWI) in association with pathologic upgrading in endometrial cancer.

Study type: Retrospective.

Subjects: Preoperative MRI datasets of 221 patients with grade I endometrial cancer on endometrial biopsy (n = 146), dilatation and curettage (n = 66), or either (n = 9).

Field strength/sequence: 3.0T, including T2 -weighted imaging, DWI with a b-value of 1000 s/mm2 , and dynamic contrast enhanced imaging.

Assessment: The tumor size was determined as the longest diameter of the lesion. The minimum apparent diffusion coefficient (ADCmin ) was calculated using histogram analysis of the entire tumor.

Statistical tests: Mann-Whitney U-test, Pearson's chi-square test, Fisher's exact test, intraclass correlation coefficient (ICC) analysis, receiver operating characteristic (ROC) curve analysis, univariate and multivariate logistic regression analysis.

Results: Pathologic upgrading was identified in 42 patients (19.0%). Patients with pathologic upgrading had larger tumors and showed lower ADCmin values than those without pathologic upgrading (both P < 0.001). The area under the ROC curve of ADCmin and tumor size was 0.812 and 0.758, respectively. On multivariate analysis, tumor ADCmin ≤0.600 × 10-3 mm2 /s (odds ratio [OR], 11.8; P < 0.001) and tumor size on MRI >3 cm (OR, 3.24; P = 0.009) were independently associated with pathologic upgrading. Upgrading occurred in 23 of 31 patients (74.2%) with ADCmin ≤0.600 × 10-3 mm2 /s and tumor size >3 cm, and in 7 of 114 patients (6.1%) with ADCmin >0.600 × 10-3 mm2 /s and tumor size ≤3 cm.

Data conclusion: Tumor ADC and tumor size on MRI may be useful parameters in association with pathologic upgrading in biopsy-proven grade I endometrial cancer.

Level of evidence: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2020;51:117-123.

Keywords: diffusion weighted MRI; endometrial cancer; magnetic resonance imaging; neoplasm grading.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biopsy
  • Diffusion Magnetic Resonance Imaging / methods*
  • Dilatation and Curettage
  • Endometrial Neoplasms / diagnostic imaging*
  • Endometrial Neoplasms / pathology*
  • Endometrium / diagnostic imaging
  • Endometrium / pathology
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted / methods*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tumor Burden