Combining tumor size and diffusion-weighted imaging to diagnose normal-sized metastatic pelvic lymph nodes in cervical cancers

Abstract

Background Detecting normal-sized metastatic pelvic lymph nodes (LNs) in cervical cancers, although difficult, is of vital importance. Purpose To investigate the value of diffusion-weighted-imaging (DWI), tumor size, and LN shape in predicting metastases in normal-sized pelvic LNs in cervical cancers. Material and Methods Pathology confirmed cervical cancer patients with complete magnetic resonance imaging (MRI) were documented from 2011 to 2016. A total of 121 cervical cancer patients showed small pelvic LNs (<5 mm) and 92 showed normal-sized (5-10 mm) pelvic LNs (39 patients with 55 nodes that were histologically metastatic, 53 patients with 71 nodes that were histologically benign). Preoperative clinical and MRI variables were analyzed and compared between the metastatic and benign groups. Results LN apparent diffusion coefficient (ADC) values and short-to-long axis ratios were not significantly different between metastatic and benign normal-sized LNs (0.98 ± 0.15 × 10 vs. 1.00 ± 0.18 × 10 mm/s, P = 0.45; 0.65 ± 0.16 vs. 0.64 ± 0.16, P = 0.60, respectively). Tumor ADC value of the metastatic LNs was significantly lower than the benign LNs (0.98 ± 0.12 × 10 vs. 1.07 ± 0.21 × 10 mm/s, P = 0.01). Tumor size (height) was significantly higher in the metastatic LN group (27.59 ± 9.18 mm vs. 21.36 ± 10.40 mm, P < 0.00). Spiculated border rate was higher in the metastatic LN group (9 [16.4%] vs. 3 [4.2%], P = 0.03). Tumor (height) combined with tumor ADC value showed the highest area under the curve of 0.702 ( P < 0.00) in detecting metastatic pelvic nodes, with a sensitivity of 59.1% and specificity of 78.8%. Conclusions Tumor DWI combined with tumor height were superior to LN DWI and shape in predicting the metastatic state of normal-sized pelvic LNs in cervical cancer patients.

Application of apparent diffusion coefficient values derived from diffusion-weighted imaging for assessing different sized metastatic lymph nodes in cervical cancers

“…DWI has the potential to detect malignant tumors and enlarged metastatic LNs, but few studies focused on the diagnostic efficiency in detecting normal-sized metastatic LNs (11,22,23). Our study revealed that ADC mean and ADC min in enlarged metastatic LNs were significantly lower than that of benign LNs by DWI applying b values of 800 s/mm 2 (0.89 AE 0.13 Â 10 -3 mm 2 /s vs. 1.02 AE 0.13 Â 10 -3 mm 2 /s, 0.64 AE 0.15 Â 10 -3 mm 2 /s vs. 0.81 AE 0.12 Â 10 -3 mm 2 /s; P < 0.001, respectively).…”

Preoperative magnetic resonance imaging criteria for predicting lymph node metastasis in patients with stage IB1‐IIA2 cervical cancer

“…Tumor diameter is considered a good prognostic indicator of p‐LNM 6 . Several previous studies have demonstrated that MRI is the optimal imaging modality for estimating tumor diameter 10‐12 . Additionally, correlation with postoperative measurement in tumor size was higher for MRI than for pelvic examination in patients with cervical cancer 18 .…”

“…For patients with limited tumor diameter, stromal invasion, lymphovascular space invasion, parametrial involvement, or uterine corpus invasion, the rate of p‐LNM could be significantly decreased 6‐8 ; however, these parameters, except for tumor diameter, were obtained from postoperative pathological examinations. Although preoperative evaluations of lymph node status are limited, preoperative magnetic resonance imaging (MRI) could potentially be used to evaluate the risk of p‐LNM and to perform accurate and reproducible assessments of the tumor diameter 9‐12 9‐12 …”

“…Although preoperative evaluations of lymph node status are limited, preoperative magnetic resonance imaging (MRI) could potentially be used to evaluate the risk of p‐LNM and to perform accurate and reproducible assessments of the tumor diameter 9‐12 9‐12 …”

Nomogram for predicting the overall survival of cervical cancer patients with nonsurgical treatment

“…The lymph node information in the cohort we studied was derived from biopsy or aspiration, but we could exert more clinically feasible methods to predict lymph node metastasis. Research shows that magnetic resonance imaging variables [31] and 18F-uorodeoxyglucose positron emission tomography [32] can improve the accuracy of predicting lymph node metastasis. Remarkably, degree of invasion and treatment measures had the compelling prognostic value for OS, which coincided with previous reports [33].…”