Preoperative Prediction Value of Pelvic Lymph Node Metastasis of Endometrial Cancer: Combining of ADC Value and Radiomics Features of the Primary Lesion and Clinical Parameters

Abstract

Objective. To investigate the value of apparent diffusion coefficient (ADC) value of endometrial cancer (EC) primary lesion and magnetic resonance imaging (MRI) three-dimensional (3D) radiomics features combined with clinical parameters for preoperative prediction of pelvic lymph node metastasis (PLNM). Methods. A total of 136 patients with EC confirmed by postoperative pathology were retrospectively reviewed and analyzed. Patients were randomly divided into training set (n = 95) and test set (n = 41) at a ratio of 7 : 3. Radiomics features based on T2WI, DWI, and contrast-enhanced T1WI (CE-T1WI) sequence were extracted and screened, and then radiomics score (Rads-score) was calculated. Clinical parameters and ADC value of EC primary lesion were measured and collected, and their correlation with PLNM was analyzed. Receiver operating characteristic (ROC) curve was plotted to assess the diagnostic efficacy of the model. A nomogram for PLNM was created based on the multivariate logistic regression model. Results. The ADC value of the EC primary lesion showed inverse correlation with PLNM, while CA125 and Rads-score were positively associated with PLNM. A predictive model was proposed based on ADC value, Rads-score, CA125, and MR-reported pelvic lymph node status (PLNS) for PLNM in EC. The area under the curve (AUC) of the model is 0.940; the sensitivity and specificity (87.1% and 90.6%) of the model were significantly higher than that of the MRI morphological signs. Conclusion. A combination of ADC value, MRI 3D radiomics features of the EC primary lesion, and clinical parameters generated a prediction model for PLNM in EC and had a good diagnostic performance; it was a useful supplement to MR-reported PLNS based on MRI morphological signs.

The value of machine learning in preoperative identification of lymph node metastasis status in endometrial cancer: a systematic review and meta-analysis

“…Among them, 11 studies ( 21 , 30 , 31 , 33 , 36 , 45 , 55 , 61 – 63 , 65 ) adopted the method of external validation, and the remaining studies carried out internal validation by random sampling. Nine studies ( 20 – 22 , 31 , 32 , 35 , 45 , 52 ) did not clearly describe the variable screening method and mainly adopted single-factor and multi-factor logistic regression.…”

Metastases and Recurrence Risk Factors in Endometrial Cancer—The Role of Selected Molecular Changes, Hormonal Factors, Diagnostic Methods and Surgery Procedures

“…Numerous studies have shown that such a two-step strategy combining preoperative histopathologic evaluation with ultrasound evaluation of myometrial and cervical stroma invasion helps identify cases at high and low risk of lymph node metastasis with a sensitivity and specificity of 83% and 71%, respectively [ 44 , 45 ].…”

Relationship between 18F-fluorodeoxyglucose PET/computed tomography metabolic parameters and clinicopathology in endometrial cancer

“…Federation of Gynecology and Obstetrics (FIGO) stage, serum cancer antigen 125 (CA-125) and human epididymis protein 4 (HE4), and histologic molecular markers have been investigated and analyzed in the diagnosis and prognosis of EC patients [7][8][9][10]. Meanwhile, 18F-fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (CT) combines morphological and physiologic imaging techniques and is widely used for diagnosis, staging and prognosis of various cancers.…”

“…This may be because of different histological types and sample sizes. Ki-67 is a marker of cell proliferation, suggesting that higher Ki-67 index, higher proliferative activity, stronger invasiveness, and higher cell density [7]. 18 F-FDG PET/CT metabolic parameters had been proven to play an important role in identifying tumors with high proliferation and aggressive behavior in clinical practice.…”