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The role of diffusion magnetic resonance imaging in determining tumor aggressiveness during preoperative surgical planning in early-stage endometrial cancer

Bedeutung der Diffusionsmagnetresonanztomographie bei der Bestimmung der Tumoraggressivität während der präoperativen Planung bei Endometriumkarzinom im Frühstadium

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Abstract

Purpose

The present study aimed to evaluate the relationship between tumor volume and apparent diffusion coefficient (ADC) in preoperative magnetic resonance imaging and deep myometrial invasion, tumor grade, and lymphovascular space invasion (LVSI) in patients with early-stage endometrial cancer.

Methods

The study included 73 patients diagnosed with early-stage endometrial cancer based on histopathological examination between May 2014 and July 2019. Receiver operating characteristic (ROC) curve analysis was used to estimate the accuracy of ADC and tumor volume in predicting the LVSI, the depth of myometrial invasion (DMI), and the histopathological tumor grade in these patients.

Results

The areas under the ROC curves (AUCs) of ADC and tumor volume in predicting LVI, DMI, and high tumor grade were significantly greater than those for superficial myometrial invasion and low-grade tumors. The ROC analysis revealed that higher tumor volume was significantly associated with the prediction of DMI and tumor grade (p = 0.002 and p = 0.015). The corresponding cut-off values of tumor volume were > 7.12 and > 9.38 mL. The sensitivity of ADC in predicting DMI was higher than its sensitivity in predicting LVSI and grade 1 tumors. Furthermore, tumor volume was significantly associated with the prediction of DMI and tumor grade.

Conclusion

In the absence of pathological pelvic lymph nodes in early-stage endometrial cancer, tumor volume in DWI sequences determines the active tumor load and tumor aggressiveness. Furthermore, a low ADC indicates deep myometrial invasion and helps differentiate stage IA and stage IB tumors.

Zusammenfassung

Ziel

Ziel der vorliegenden Studie war es, den Zusammenhang zwischen dem Tumorvolumen und dem apparenten Diffusionskoeffizienten (ADC) bei der präoperativen Magnetresonanztomographie zu beurteilen sowie tiefer myometrialer Invasion, Tumorgrading und lymphovaskulärer Invasion bei Patientinnen mit Endometriumkarzinom im Frühstadium.

Methoden

In die Studie wurden 73 Patientinnen zwischen Mai 2014 und Juli 2019 mit der auf einer histopathologischen Untersuchung basierenden Diagnose eines Endometriumkarzinoms im Frühstadium einbezogen. Die Receiver-Operating-Characteristic(ROC)-Curve-Analyse wurde eingesetzt, um die Genauigkeit des ADC und des Tumorvolumens bei der Vorhersage der Invasion in den lymphovaskulären Raum („lymphovascular space invasion“ [LVSI]) abzuschätzen, die Tiefe der myometrialen Invasion („depth of myometrial invasion“ [DMI]) und das histopathologische Tumorgrading bei diesen Patientinnen.

Ergebnisse

Die Flächen unter den ROC-Kurven („area under the curve“ [AUC]) von ADC und Tumorvolumen bei der Vorhersage von LVI, DMI und hohem Tumorgrading waren signifikant größer als die Flächen für oberflächliche myometriale Invasion und Low-Grade-Tumoren. Die ROC-Analyse ergab, dass ein höheres Tumorvolumen in signifikanter Weise mit der Vorhersage von DMI und Tumorgrading einherging (p = 0,002 bzw. p = 0,015). Die entsprechenden Grenzwerte des Tumorvolumens betrugen > 7,12 bzw. > 9,38 ml. Die Sensitivität des ADC bei der Vorhersage der DMI war höher als seine Sensitivität bei der Vorhersage von LVSI und Grad-1-Tumoren. Darüber hinaus stand das Tumorvolumen in signifikanter Weise mit der Vorhersage von DMI und Tumorgrading in Zusammenhang.

Schlussfolgerung

Sind keine pathologischen Beckenlymphknoten beim Endometriumkarzinom im Frühstadium vorhanden, so bestimmt das Tumorvolumen in DWI-Sequenzen die aktive Tumorlast und Tumoraggressivität. Außerdem zeigt ein geringer ADC eine tiefe myometriale Invasion an und hilft dabei, Tumoren im Stadium IA und IB zu differenzieren

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Radiology, Akdeniz University School of Medicine, Dumlupınar bulvarı, 07059, Arapsuyu, Antalya, Turkey

    Ayşe Keven MD, Emel Emir Yetim, Aygül Elmalı, Ahmet Gökhan Arslan & Süleyman Metin Çubuk

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  1. Ayşe Keven MD
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  2. Emel Emir Yetim
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  3. Aygül Elmalı
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  4. Ahmet Gökhan Arslan
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  5. Süleyman Metin Çubuk
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Contributions

Ayşe Keven was responsible for reviewing the literature and writing the full manuscript and the approval of the manuscript. Emel Emir Yetim and Aygül Elmali were responsible for coordinated and supervised data collection, and they reviewed and revised the manuscript. Ahmet Gökhan Arslan and Süleyman Metin Çubuk were responsible for the final review and approval of the manuscript.

Corresponding author

Correspondence to Ayşe Keven MD.

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Conflict of interest

A. Keven, E.E. Yetim, A. Elmalı, A.G. Arslan and S.M. Çubuk declare that they have no competing interests.

This study was a single-center study approved by the ethics committee of the university (27.01.2021/73). Informed consent was signed by patients according to the World Medical Association Declaration of Helsinki, revised in 2000, Edinburgh. Written informed consent was waived by the local ethics committee.

The supplement containing this article is not sponsored by industry.

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Keven, A., Yetim, E.E., Elmalı, A. et al. The role of diffusion magnetic resonance imaging in determining tumor aggressiveness during preoperative surgical planning in early-stage endometrial cancer. Radiologie 63 (Suppl 2), 41–48 (2023). https://doi.org/10.1007/s00117-023-01134-7

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  • DOI: https://doi.org/10.1007/s00117-023-01134-7

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