Park Jung Jae, Kim Chan Kyo, Cho Seong Whi, Kim Jae-Hun
Department of Radiology, Chungnam National University Hospital, Daejeon, Republic of Korea.
Department of Radiology, Kangwon National University Hospital, Chuncheon, Republic of Korea.
J Magn Reson Imaging. 2020 Jan;51(1):117-123. doi: 10.1002/jmri.26840. Epub 2019 Jun 17.
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.
To investigate the utility of diffusion-weighted imaging (DWI) in association with pathologic upgrading in endometrial cancer.
Retrospective.
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 T -weighted imaging, DWI with a b-value of 1000 s/mm , and dynamic contrast enhanced imaging.
The tumor size was determined as the longest diameter of the lesion. The minimum apparent diffusion coefficient (ADC ) was calculated using histogram analysis of the entire tumor.
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.
Pathologic upgrading was identified in 42 patients (19.0%). Patients with pathologic upgrading had larger tumors and showed lower ADC values than those without pathologic upgrading (both P < 0.001). The area under the ROC curve of ADC and tumor size was 0.812 and 0.758, respectively. On multivariate analysis, tumor ADC ≤0.600 × 10 mm /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 ADC ≤0.600 × 10 mm /s and tumor size >3 cm, and in 7 of 114 patients (6.1%) with ADC >0.600 × 10 mm /s and tumor size ≤3 cm.
Tumor ADC and tumor size on MRI may be useful parameters in association with pathologic upgrading in biopsy-proven grade I endometrial cancer.
4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2020;51:117-123.
病理升级的预测对于识别活检证实为I级子宫内膜癌的年轻患者中保留生育功能激素治疗的最佳候选者具有临床意义。
探讨扩散加权成像（DWI）与子宫内膜癌病理升级的相关性。
回顾性研究。
221例经子宫内膜活检（n = 146）、刮宫术（n = 66）或两者皆有（n = 9）确诊为I级子宫内膜癌患者的术前MRI数据集。
场强/序列：3.0T，包括T加权成像、b值为1000 s/mm²的DWI和动态对比增强成像。
肿瘤大小确定为病变的最长直径。使用整个肿瘤的直方图分析计算最小表观扩散系数（ADC）。
曼-惠特尼U检验、皮尔逊卡方检验、费舍尔精确检验、组内相关系数（ICC）分析、受试者工作特征（ROC）曲线分析、单因素和多因素逻辑回归分析。
42例患者（19.0%）出现病理升级。与未发生病理升级的患者相比，发生病理升级的患者肿瘤更大，ADC值更低（均P < 0.001）。ADC和肿瘤大小的ROC曲线下面积分别为0.812和0.758。多因素分析显示，肿瘤ADC≤0.600×10⁻³mm²/s（比值比[OR]，11.8；P < 0.001）和MRI上肿瘤大小>3 cm（OR，3.24；P = 0.009）与病理升级独立相关。在31例ADC≤0.600×10⁻³mm²/s且肿瘤大小 > 3 cm的患者中，23例（74.2%）发生升级；在114例ADC>0.600×10⁻³mm²/s且肿瘤大小≤3 cm的患者中，7例（6.1%）发生升级。
MRI上的肿瘤ADC和肿瘤大小可能是活检证实为I级子宫内膜癌病理升级的有用参数。
4 技术效能：3级 J.Magn.Reson.Imaging 2020;51:117 - 123。
