Apparent diffusion coefficient by diffusion-weighted magnetic resonance imaging as a sole biomarker for staging and prognosis of gastric cancer

Abstract

ObjectiveTo investigate the role of apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) when applied to the 7th TNM classification in the staging and prognosis of gastric cancer (GC).MethodsBetween October 2009 and May 2014, a total of 89 patients with non-metastatic, biopsy proven GC underwent 1.5T DW-MRI, and then treated with radical surgery. Tumor ADC was measured retrospectively and compared with final histology following the 7th TNM staging (local invasion, nodal involvement and according to the different groups — stage I, II and III). Kaplan-Meier curves were also generated. The follow-up period is updated to May 2016.ResultsMedian follow-up period was 33 months and 45/89 (51%) deaths from GC were observed. ADC was significantly different both for local invasion and nodal involvement (P<0.001). Considering final histology as the reference standard, a preoperative ADC cut-off of 1.80×10–3 mm2/s could distinguish between stages I and II and an ADC value of ≤1.36×10–3 mm2/s was associated with stage III (P<0.001). Kaplan-Meier curves demonstrated that the survival rates for the three prognostic groups were significantly different according to final histology and ADC cut-offs (P<0.001). ConclusionsADC is different according to local invasion, nodal involvement and the 7th TNM stage groups for GC, representing a potential, additional prognostic biomarker. The addition of DW-MRI could aid in the staging and risk stratification of GC.

Imaging strategies in the management of gastric cancer: current role and future potential of MRI

“…35 Furthermore ADC values increase gradually with the degree of histologic tumor differentiation 32,37,132 and there is an inverse correlation between the ADC value and the T-and N-stage. 133,134 Its correlation with the Her2Neu status of gastric tumors has been described 135,136 and it could also be useful in response prediction to neoadjuvant treatment as discussed before. 133 Lastly, lower tumor ADC values are associated with a negative prognosis (i.e.…”

“…overall survival) and could potentially serve as prognostic factor in the evaluation of aggressiveness of gastric cancer. 134,137,138 One of the challenges specifically for the use of ADC values of DW-MRI in clinical practice, is that there is no consensus how to calculate and interpret ADC values. ADC values are calculated based on a region of interest (ROI), but the approach of determination of this ROI varies greatly between studies.…”

Comparison of DWI and 18F-FDG PET/CT for assessing preoperative N-staging in gastric cancer: evidence from a meta-analysis

“…A total of 299 articles were screened in the primary literature search. After removing the ineligible study in each step, 15 studies (six studies [ 46 – 51 ] for DWI and nine studies [ 21 , 38 – 41 , 52 – 55 ] for 18 F-FDG PET/CT were finally selected on basis of the inclusion and exclusion criteria. A flowchart depicting the study selection process is shown in Figure 1 .…”

“…The overall accuracy is higher when the reference standard is based on ADC (ADC < 1.189×10 –3 mm 2 /s) than when based on the short axis diameter (SAD) (SAD > 5.05 mm) [ 50 ]. A study by Giganti et al proved that ADC value significantly differed according to local invasion, nodal involvement and the AJCC Cancer Staging Manual, 7th Edition TNM stage groups for GC, indicating that the ADC was potentially useful in the staging and risk stratification of GC patients [ 46 ]. Although Hasbahceci et al [ 49 ] demonstrated that ADC value did not aid in distinguishing metastatic lymph nodes, this contrary conclusion was based on study of only 23 GC subjects and was not convincing.…”

Gastric cancer and imaging biomarkers: Part 1 – a critical review of DW-MRI and CE-MDCT findings

“…The first study [37] reports that an ADC of 1.8 × 10 -3 mm 2 /s may discriminate between stage I and stage II and that values ≤ 1.36 × 10 -3 mm 2 /s are associated with stage III. The second paper [51] shows that an ADC ≤ 1.5 × 10 -3 mm 2 /s is related to a negative outcome, along with T and N stages after surgery.…”