Department of Imaging, Barts and The London NHS Trust, London, UK.
Br J Radiol. 2011 Nov;84(1007):997-1004. doi: 10.1259/bjr/14980811. Epub 2011 Sep 6.
Endometrial cancer is the most common gynaecological malignancy in developed countries. Histological grade and subtype are important prognostic factors obtained by pipelle biopsy. However, pipelle biopsy "samples" tissue and a high-grade component that requires more aggressive treatment may be missed. The purpose of the study was to assess the use of diffusion-weighted MRI (DW-MRI) in the assessment of tumour grade in endometrial lesions.
42 endometrial lesions including 23 endometrial cancers and 19 benign lesions were evaluated with DW-MRI (1.5T with multiple b-values between 0 and 750 s mm(-2)). Visual evaluation and the calculation of mean and minimum apparent diffusion coefficient (ADC) value were performed and correlated with histology.
The mean and minimum ADC values for each histological grade were 1.02 ± 0.29×10(-3) mm(2) s(-1) and 0.74 ± 0.24×10(-3) mm(2) s(-1) (grade 1), 0.88 ± 0.39×10(-3) mm(2) s(-1) and 0.64 ± 0.36×10(-3) mm(2) s(-1) (grade 2), and 0.94 ± 0.32×10(-3) mm(2) s(-1) and 0.72 ± 0.36×10(-3) mm(2) s(-1) (grade 3), respectively. There was no statistically significant difference between tumour grades. However, the mean ADC value for endometrial carcinoma was 0.97 ± 0.31, which was significantly lower (p<0.0001) than that of benign endometrial pathology (1.50 ± 0.14). Applying a cut-off mean ADC value of less than 1.28 × 10(-3) mm(2) s(-1)we obtained a sensitivity, specificity, positive predictive value and negative predictive value for malignancy of 87%, 100%, 100% and 85.7%, respectively.
Tumour mean and minimum ADC values are not useful in differentiating histological tumour grade in endometrial carcinoma. However, mean ADC measurement can provide useful information in differentiating benign from malignant endometrial lesions. This information could be clinically relevant in those patients where pre-operative endometrial sampling is not possible.
子宫内膜癌是发达国家最常见的妇科恶性肿瘤。组织学分级和亚型是通过 Pipelle 活检获得的重要预后因素。然而，Pipelle 活检“取样”的组织和需要更积极治疗的高级别成分可能会被遗漏。本研究旨在评估扩散加权 MRI（DW-MRI）在评估子宫内膜病变肿瘤分级中的应用。
42 例子宫内膜病变，包括 23 例子宫内膜癌和 19 例良性病变，均行 DW-MRI（1.5T，b 值在 0 到 750 s/mm(-2)之间）检查。对 DW-MRI 进行视觉评估，并计算平均及最小表观扩散系数（ADC）值，与组织学进行相关性分析。
每个组织学分级的平均 ADC 值和最小 ADC 值分别为 1.02 ± 0.29×10(-3)mm(2) s(-1)和 0.74 ± 0.24×10(-3)mm(2) s(-1)（1 级）、0.88 ± 0.39×10(-3)mm(2) s(-1)和 0.64 ± 0.36×10(-3)mm(2) s(-1)（2 级）、0.94 ± 0.32×10(-3)mm(2) s(-1)和 0.72 ± 0.36×10(-3)mm(2) s(-1)（3 级）。肿瘤分级之间无统计学差异。然而，子宫内膜癌的平均 ADC 值为 0.97 ± 0.31，显著低于良性子宫内膜病变（1.50 ± 0.14）（p<0.0001）。应用低于 1.28×10(-3)mm(2) s(-1)的平均 ADC 值截断值，我们得到恶性肿瘤的灵敏度、特异性、阳性预测值和阴性预测值分别为 87%、100%、100%和 85.7%。
肿瘤的平均 ADC 值和最小 ADC 值在鉴别子宫内膜癌的组织学肿瘤分级方面没有用处。然而，平均 ADC 值测量可以提供有用的信息，有助于区分良性和恶性子宫内膜病变。在那些术前无法进行子宫内膜取样的患者中，这一信息可能具有临床相关性。
