Preoperative prediction of deep myometrial invasion and tumor grade for stage I endometrioid adenocarcinoma: a simple method of measurement on DWI
- 123 Downloads
To explore the utility of the tumor area ratio (TAR) for predicting deep myometrial invasion and tumor grade in stage I endometrioid adenocarcinoma (EEA).
We retrospectively evaluated 86 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I EEA. All patients underwent unenhanced contrast MRI and diffusion-weighted imaging (DWI) procedures. The volume and maximum area of the tumor and uterus were obtained, and the tumor volume ratio (TVR) and TAR were calculated. The Kruskal-Wallis test and Mann-Whitney U test were used to compare the differences in indexes (TVR and TAR) between the different tumor grades and between superficial and deep myometrial invasion.
The TVR and TAR values for deep myometrial invasion and high-grade EEA tumors were significantly higher than the values for superficial myometrial invasion and low-grade tumors (all p = 0.000). According to the receiver-operating characteristic (ROC) curve, the area under the curve (AUC) was significantly higher for TAR than for TVR for tumors with deep myometrial invasion (0.936 vs. 0.844, p = 0.045). However, no significant differences in the AUCs for TVR and TAR were observed between high- and low-grade tumors (0.865 vs. 0.863, p = 0.956). A TAR ≥ 34.6% predicted deep myometrial invasion in EEA with a sensitivity, specificity, and accuracy of 85.0%, 84.8%, and 86.0%, respectively. A TAR ≥ 38.9% predicted high-grade tumors with a sensitivity, specificity, and accuracy of 83.3%, 81.1%, and 82.6%, respectively.
TAR is useful for predicting deep myometrial invasion and high-grade stage I EEA
• TAR is useful for predicting risk factors for EEA.
• TAR is easy to obtain and has high accuracy.
• TAR has excellent interobserver repeatability agreement (ICC range 95.1–99.6%).
KeywordsEndometrioid adenocarcinoma Cell differentiation Neoplasm staging Diffusion Magnetic resonance imaging
Area under the curve
International Federation of Gynecology and Obstetrics
Interobserver correlation coefficient
Magnetic resonance imaging
Negative predictive value
Positive predictive value
Receiver-operating characteristic curve
Tumor area ratio
Tumor volume ratio
This study received funding from the Fundamental Research Funds for the Central Universities of China (1191320118).
Compliance with ethical standards
The scientific guarantor of this publication is Bin Yan, Department of Radiology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, P.R China.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors (Wenjun Liu) has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in: Yan B et al Can the apparent diffusion coefficient differentiate the grade of endometrioid adenocarcinoma and the histological subtype of endometrial cancer? Acta Radiol, 2018, 59:363-370.
• diagnostic or prognostic study
• performed at one institution
- 25.Kurman RJ, Carcangiu ML, Herrington CS, Young RH (2014) WHO Classification of Tumours of Female Reproductive Organs, 4th edn. IARC Press, LyonGoogle Scholar