Skip to main content
SpringerLink
Log in

Preoperative prediction of deep myometrial invasion and tumor grade for stage I endometrioid adenocarcinoma: a simple method of measurement on DWI

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To explore the utility of the tumor area ratio (TAR) for predicting deep myometrial invasion and tumor grade in stage I endometrioid adenocarcinoma (EEA).

Methods

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.

Results

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.

Conclusion

TAR is useful for predicting deep myometrial invasion and high-grade stage I EEA

Key Points

• 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%).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

AUC:

Area under the curve

CE-MRI:

Contrast-enhanced MRI

CI:

Confidence interval

DWI:

Diffusion-weighted imaging

EC:

Endometrial cancer

EEA:

Endometrioid adenocarcinoma

FIGO:

International Federation of Gynecology and Obstetrics

ICC:

Interobserver correlation coefficient

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver-operating characteristic curve

TAR:

Tumor area ratio

TV:

Tumor volume

TVR:

Tumor volume ratio

References

  1. Teng F, Zhang YF, Wang YM et al (2015) Contrast-enhanced MRI in preoperative assessment of myometrial and cervical invasion, and lymph node metastasis: diagnostic value and error analysis in endometrial carcinoma. Acta Obstet Gynecol Scand 94:266–273

    Article  Google Scholar 

  2. Yan B, Zhao TT, Liang XF, Niu C, Ding CX (2018) Can the apparent diffusion coefficient differentiate the grade of endometrioid adenocarcinoma and the histological subtype of endometrial cancer? Acta Radiol 59:363–370

    Article  Google Scholar 

  3. Benedetti PP, Basile S, Maneschi F et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716

    Article  Google Scholar 

  4. Luomaranta A, Butzow R, Pauna AR, Leminen A, Loukovaara M (2015) Combined use of endometrial sample and magnetic resonance imaging in the preoperative risk-stratification of endometrial carcinomas. Acta Obstet Gynecol Scand 94:95–101

    Article  Google Scholar 

  5. Kinkel K, Forstner R, Danza FM et al (2009) Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging. Eur Radiol 19:1565–1574

    Article  CAS  Google Scholar 

  6. Zhang L, Liu A, Zhang T, Song Q, Wei Q, Wang H (2015) Use of diffusion tensor imaging in assessing superficial myometrial invasion by endometrial carcinoma: a preliminary study. Acta Radiol 56:1273–1280

    Article  Google Scholar 

  7. Meissnitzer M, Forstner R (2016) MRI of endometrium cancer—how we do it. Cancer Imaging 16:11

    Article  Google Scholar 

  8. Bakir B, Sanli S, Bakir VL et al (2017) Role of diffusion weighted MRI in the differential diagnosis of endometrial cancer, polyp, hyperplasia, and physiological thickening. Clin Imaging 41:86–94

    Article  Google Scholar 

  9. Park SB (2016) Functional MR imaging in gynecologic malignancies: current status and future perspectives. Abdom Radiol (NY) 41:2509–2523

    Article  Google Scholar 

  10. Das SK, Niu XK, Wang JL et al (2014) Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis. Cancer Imaging 14:32

    Article  Google Scholar 

  11. Lin G, Ng KK, Chang CJ, Wang JJ, Ho KC, Wu TI (2009) Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging—initial experience. Radiology 250:784–792

    Article  Google Scholar 

  12. Andreano A, Rechichi G, Rebora P, Sironi S, Valsecchi MG, Galimberti S (2014) MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis. Eur Radiol 24:1327–1338

    Article  Google Scholar 

  13. Woo S, Cho JY, Kim SY, Kim SH (2014) Histogram analysis of apparent diffusion coefficient map of diffusion-weighted MRI in endometrial cancer: a preliminary correlation study with histological grade. Acta Radiol 55:1270–1277

    Article  Google Scholar 

  14. Tamai K, Koyama T, Saga T et al (2007) Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 26:682–687

    Article  Google Scholar 

  15. Nakamura K, Imafuku N, Nishida T et al (2012) Measurement of the minimum apparent diffusion coefficient (ADCmin) of the primary tumor and CA125 are predictive of disease recurrence for patients with endometrial cancer. Gynecol Oncol 124:335–339

    Article  CAS  Google Scholar 

  16. Seo JM, Kim CK, Choi D, Kwan PB (2013) Endometrial cancer: utility of diffusion-weighted magnetic resonance imaging with background body signal suppression at 3T. J Magn Reson Imaging 37:1151–1159

    Article  Google Scholar 

  17. Nougaret S, Reinhold C, Alsharif SS et al (2015) Endometrial cancer: combined MR volumetry and diffusion-weighted imaging for assessment of myometrial and lymphovascular invasion and tumor grade. Radiology 276:797–808

    Article  Google Scholar 

  18. Kishimoto K, Tajima S, Maeda I et al (2016) Endometrial cancer: correlation of apparent diffusion coefficient (ADC) with tumor cellularity and tumor grade. Acta Radiol 57:1021–1028

    Article  Google Scholar 

  19. Rechichi G, Galimberti S, Signorelli M et al (2011) Endometrial cancer: correlation of apparent diffusion coefficient with tumor grade, depth of myometrial invasion, and presence of lymph node metastases. AJR Am J Roentgenol 197:256–262

    Article  Google Scholar 

  20. Bharwani N, Miquel ME, Sahdev A, Naeayanan P (2011) Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer. Br J Radiol 84:997–1004

    Article  CAS  Google Scholar 

  21. Mainenti PP, Pizzuti LM, Segreto S et al (2016) Diffusion volume (DV) measurement in endometrial and cervical cancer: a new MRI parameter in the evaluation of the tumor grading and the risk classification. Eur J Radiol 85:113–124

    Article  Google Scholar 

  22. Husby JA, Salvesen ØO, Magnussen IJ et al (2015) Tumour apparent diffusion coefficient is associated with depth of myometrial invasion and is negatively correlated to tumour volume in endometrial carcinomas. Clin Radiol 70:487–494

    Article  CAS  Google Scholar 

  23. Todo Y, Choi HJ, Kang S et al (2013) Clinical significance of tumor volume in endometrial cancer: a Japan-Korea cooperative study. Gynecol Oncol 131:294–298

    Article  Google Scholar 

  24. Bourgioti C, Chatoupis K, Tzavara C, Antoniou A, Rodolakis A, Moulopoulos LA (2016) Predictive ability of maximal tumor diameter on MRI for high-risk endometrial cancer. Abdom Radiol (NY) 41:2484–2495

    Article  Google Scholar 

  25. Kurman RJ, Carcangiu ML, Herrington CS, Young RH (2014) WHO Classification of Tumours of Female Reproductive Organs, 4th edn. IARC Press, Lyon

    Google Scholar 

  26. Husby JA, Reitan BC, Biermann M (2015) Metabolic tumor volume on 18F-FDG PET/CT improves preoperative identification of high-risk endometrial carcinoma patients. J Nucl Med 56:1191–1198

    Article  CAS  Google Scholar 

  27. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I (2005) Endometrial cancer. Lancet 366:491–505

    Article  Google Scholar 

Download references

Funding

This study received funding from the Fundamental Research Funds for the Central Universities of China (1191320118).

Author information

Authors and Affiliations

  1. Department of Radiology, Shaanxi Provincial Tumor Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710061, People’s Republic of China

    Bin Yan & Xiufen Liang

  2. Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710061, People’s Republic of China

    Tingting Zhao & Chen Niu

  3. Department of Pathology, Shaanxi Provincial Tumor Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710061, People’s Republic of China

    Caixia Ding

  4. Department of Epidemiology and Biotatistics, School of Public Health, Xi’an Jiaotong University, Xi’an Shaanxi, 710061, People’s Republic of China

    Wenjun Liu

Authors
  1. Bin Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiufen Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tingting Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chen Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caixia Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wenjun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bin Yan.

Ethics declarations

Guarantor

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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

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.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yan, B., Liang, X., Zhao, T. et al. Preoperative prediction of deep myometrial invasion and tumor grade for stage I endometrioid adenocarcinoma: a simple method of measurement on DWI. Eur Radiol 29, 838–848 (2019). https://doi.org/10.1007/s00330-018-5653-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5653-2

Keywords

Search

Navigation