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Apparent diffusion coefficient as a potential marker for tumour differentiation, staging and long-term clinical outcomes in gallbladder cancer

European Radiology volume 29, pages 411–421 (2019)Cite this article

Abstract

Objectives

To evaluate the correlation between tumour differentiation or stage of gallbladder cancer (GBC) and the apparent diffusion coefficient (ADC), as well as to assess whether ADC value can predict long-term disease-free survival (DFS) after surgery.

Methods

This retrospective study was approved by the institutional review board and the requirement for informed consent was waived. Between March 2008 and June 2016, 79 patients who underwent magnetic resonance (MR) imaging with diffusion-weighted image and subsequent surgery for GBC were included in this study. Correlations between quantitative ADC values and tumour differentiation or stage based on the American Joint Committee on Cancer (AJCC) were assessed using Spearman’s correlation analysis. Prognostic factors for DFS were identified with multivariate Cox regression analysis using imaging and clinical characteristics.

Results

All patients were classified as having well- (n = 18), moderately (n = 35) or poorly differentiated GBCs (n = 26). The ADC value of GBCs was significantly correlated with tumour differentiation and AJCC stage (p < 0.001 and p < 0.001, respectively). Sixty-nine patients were followed up for 2.0–92.4 months (median, 23.5 months). On multivariate analysis, the significant prognostic factor for DFS was not tumour differentiation or AJCC stage but a binary tumour ADC value (hazard ratio, 4.29; p = 0.009). DFS rates were significantly different according to the classification of tumour ADC value (cut-off value = 1.04 × 10−3 mm2/s; p = 0.004).

Conclusion

The ADC value of GBCs was significantly correlated with tumour differentiation as well as AJCC stage. In addition, it predicted long-term outcomes after surgery in patients with GBC.

Key points

• ADC values of GBC and tumour differentiation were negatively correlated.

• Lower ADC values of GBC were significantly correlated with higher tumour stage.

• Tumour ADC value could be useful for risk stratification of GBC patients.

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Abbreviations

ADC:

Apparent diffusion coefficient

AJCC:

American Joint Committee on Cancer

CI:

Confidence interval

DFS:

Disease-free survival

DWI:

Diffusion-weighted imaging

GBC:

Gallbladder cancer

HR:

Hazard ratio

MR:

Magnetic resonance

NCCN:

National Comprehensive Cancer Network

PACS:

Picture archiving and communication system

ROI:

Region-of-interest

TNM:

Tumour, node and metastasis

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Funding

The authors state that this work has not received any funding.

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Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Ji Hye Min, Tae Wook Kang, Dong Ik Cha & Seong Hyun Kim

  2. Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea

    Ji Hye Min, Kyung Sook Shin & Jeong Eun Lee

  3. Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Kee-Taek Jang

  4. Department of Mathematics, Ajou University, Suwon, Republic of Korea

    Soo Hyun Ahn

Authors
  1. Ji Hye Min
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  2. Tae Wook Kang
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  3. Dong Ik Cha
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  4. Seong Hyun Kim
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  5. Kyung Sook Shin
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Corresponding author

Correspondence to Tae Wook Kang.

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Guarantor

The scientific guarantor of this publication is Won Jae Lee.

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 (Soo Hyun Ahn) has significant statistical expertise.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Retrospective

• Prognostic study

• Performed at one institution

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Min, J.H., Kang, T.W., Cha, D.I. et al. Apparent diffusion coefficient as a potential marker for tumour differentiation, staging and long-term clinical outcomes in gallbladder cancer. Eur Radiol 29, 411–421 (2019). https://doi.org/10.1007/s00330-018-5602-0

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  • DOI: https://doi.org/10.1007/s00330-018-5602-0

Keywords

  • Gallbladder neoplasms
  • Diffusion
  • Magnetic resonance imaging
  • Treatment outcome