Highlights
- •We use rADC values in predicting patients with low risk EC for the first time.
- •meanADC, minADC and rADC were significantly higher in the low risk EC than they were in the intermediate-high risk EC.
- •rADC values yield the best diagnostic efficiency.
- •ADC values aid in the selection of treatment strategies of stage I EC.
Abstract
Objectives
Lymphadenectomy is not recommended for low risk stage I endometrial carcinoma (EC)
patients. This study was to investigate the predictive value of apparent diffusion
coefficient (ADC) values in predicting patients with low risk EC, and to identify
an optimum ADC measurement for preoperative assessment.
Materials and methods
Eighty-one patients with stage I EC who underwent diffusion-weighted imaging (DWI)
at 1.5T were included and divided into low group and intermediate-high risk group
based on the ESMO-ESGO-ESTRO classification. Clinical indexes, conventional MRI parameters,
minimum ADC values (minADC), mean ADC values (meanADC) and relative ADC values (rADC)
were compared between those two groups. rADC was calculated using the equation ADC
(cancer)/ADC (reference) with the obturator internus muscle as reference. The optimal
ADC measurement and cut-off ADC value for low risk EC were calculated using the receiver
operating characteristic (ROC) curve.
Results
The low risk group had significantly higher meanADC, minADC, and rADC values than
did the intermediate-high risk group (1.095 vs. 0.902 × 10−3 mm2/s, 0.755 vs. 0.657 × 10−3 mm2/s, 0.754 vs. 0.603, respectively). In assessments of low risk EC patients, the area
under the curve (AUC) values for meanADC, minADC, and rADC were 0.840 (95%CI, 0.749,0.931),
0.681 (95% CI: 0.561,0.800), and 0.876(95% CI: 0.798,0.954), respectively. The optimal
cut-off rADC value for prediction was 0.669, the maximum Youden index, sensitivity,
specificity, and accuracy values were 0.683, 81.8%, 86.5%, and 84.0%, respectively.
Conclusions
rADC is superior to minADC and meanADC for predicting patients with low risk EC, and
could potentially aid to the surgical management of these patients in avoiding unnecessary
lymphadenectomy.
Keywords
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Article info
Publication history
Published online: March 02, 2019
Accepted:
March 1,
2019
Received in revised form:
February 11,
2019
Received:
January 3,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
