Evaluation and validation of the diagnostic value of the apparent diffusion coefficient for differentiating early-stage endometrial carcinomas from benign mimickers at 3T MRI

Abstract

Previous researchers obtained various apparent diffusion coefficient (ADC) cutoff values to differentiate endometrial carcinoma from benign mimickers with 1.5T magnetic resonance imaging (MRI). Few studies have used 3T MRI or validated the effectiveness of these cutoff ADC values prospectively. This study was designed in two stages to obtain a cutoff ADC value at 3T MRI and to validate prospectively the role of the ADC value. First, we conducted a retrospective study of 60 patients to evaluate the diagnostic value of ADC by obtain a theoretical cutoff ADC value for differentiating between benign and malignant endometrial lesions. Student's t test revealed that ADC values for stage I endometrial carcinomas were significantly lower than those for benign lesions. The area under the curve value of the receiver operating characteristic curve was 0.993, and the cutoff ADC value was 0.98 × 10−3 mm2/s. The sensitivity, specificity, and overall accuracy of diagnosing stage I endometrial carcinoma were 100%, 97.1%, and 98.3%, respectively. Second, we conducted a prospective study of 26 patients to validate the use of the cutoff ADC value obtained in the study's first stage. The sensitivity, specificity, and overall accuracy for differentiating malignant from benign endometrial lesions based on the cutoff ADC value obtained earlier were as follows: radiologist 1 attained 86.67%, 100.0%, and 92.31%, respectively; radiologist 2 attained 86.67%, 91.0%, and 88.5%, respectively. Our results suggest that ADC values could be a potential biomarker for use as a quantitative and qualitative tool for differentiating between early-stage endometrial carcinomas and benign mimickers.

The apparent diffusion coefficient (ADC) on 3-T MRI differentiates myometrial invasion depth and histological grade in patients with endometrial cancer

“…According to Wang et al. (30), age and body temperature are additional potential factors that could cause interpatient variations in ADC values. However, these factors are beyond the scope of this work and require further investigation.…”

“…On the other hand, researchers have highlighted higher SDs in ADC values in both low-and highgrade tumors (14). Thus, the critical role of intratumoral heterogeneity has been proposed, which might be reflected as discrepancies in ADC values even among patients from the same group (11,30). According to Wang et al (30), age and body temperature are additional potential factors that could cause interpatient variations in ADC values.…”

Different multiparametric MRI-based radiomics models for differentiating stage IA endometrial cancer from benign endometrial lesions: A multicenter study

“…Thus T2_exponential_GLSZM_zone percentage was also an important feature. A previous study had suggested that DWI with ADC values were a potential quantitative and qualitative tool for differentiating between early-stage EC and benign mimickers (38). On DWI, benign endometrial lesions showed low signal intensity, which was an important point in differentiating them from EC that showed high signal intensity due to relatively high cellularity (39).…”

Diagnostic Accuracy of Diffusion Weighted Magnetic Resonance in Differentiating Between Malignant and Benign Endometrial Soft-Tissue Lesions

“…Another study conducted by Wang et al reported that 40 malignant lesions out of total 42 lesions were endometrial carcinoma and 7 out of 14 benign lesions were endometrial polyps. Other benign lesions were submucosal fibroid (n=5) and endometrial hyperplasia in 2 lesions [14].…”