Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China.
Department of Radiology, the First Affiliated Hospital of Chongqing, Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China.
Clin Imaging. 2019 Jul-Aug;56:28-32. doi: 10.1016/j.clinimag.2019.03.001. Epub 2019 Mar 2.
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.
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.
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 mm/s, 0.755 vs. 0.657 × 10 mm/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.
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.
对于低危期 I 型子宫内膜癌（EC）患者，不建议进行淋巴结切除术。本研究旨在探讨表观扩散系数（ADC）值在预测低危 EC 患者中的预测价值，并确定用于术前评估的最佳 ADC 测量值。
本研究共纳入 81 例在 1.5T 下进行扩散加权成像（DWI）的 I 期 EC 患者，根据 ESMO-ESGO-ESTRO 分类将其分为低危组和中高危组。比较两组间的临床指标、常规 MRI 参数、最小 ADC 值（minADC）、平均 ADC 值（meanADC）和相对 ADC 值（rADC）。rADC 通过用闭孔内肌作为参考的公式 ADC（癌症）/ADC（参考）计算。使用受试者工作特征（ROC）曲线计算低危 EC 的最佳 ADC 测量值和截断 ADC 值。
低危组的 meanADC、minADC 和 rADC 值明显高于中高危组（1.095 比 0.902×10mm/s、0.755 比 0.657×10mm/s、0.754 比 0.603）。在评估低危 EC 患者时，meanADC、minADC 和 rADC 的曲线下面积（AUC）值分别为 0.840（95%CI：0.749，0.931）、0.681（95%CI：0.561，0.800）和 0.876（95%CI：0.798，0.954）。预测的最佳截断 rADC 值为 0.669，最大 Youden 指数、敏感性、特异性和准确性值分别为 0.683、81.8%、86.5%和 84.0%。
rADC 预测低危 EC 患者的效果优于 minADC 和 meanADC，可能有助于指导这些患者的手术管理，避免不必要的淋巴结切除术。
