Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer

Abstract

Objective: Endometrial cancer is the most common gynaecological malignancy in developed countries. Histological grade and subtype are important prognostic factors obtained by pipelle biopsy. However, pipelle biopsy ''samples'' tissue and a high-grade component that requires more aggressive treatment may be missed. The purpose of the study was to assess the use of diffusion-weighted MRI (DW-MRI) in the assessment of tumour grade in endometrial lesions. we obtained a sensitivity, specificity, positive predictive value and negative predictive value for malignancy of 87%, 100%, 100% and 85.7%, respectively. Conclusion: Tumour mean and minimum ADC values are not useful in differentiating histological tumour grade in endometrial carcinoma. However, mean ADC measurement can provide useful information in differentiating benign from malignant endometrial lesions. This information could be clinically relevant in those patients where pre-operative endometrial sampling is not possible.

Influence of menopausal status on diagnostic accuracy of myometrial invasion in endometrial cancer: diffusion-weighted and dynamic contrast-enhanced MRI at 3 T

“…This can be attributed to Type 1 cancers, which are oestrogen-sensitive and more common in a young age group. 4 The link between ADC value and tumour grade is consistent with a previous report by Tamai et al 12 from an Asian population, but not seen in another report by Bharwani et al 33 from a Western population. Indeed, this inconsistent observation can be attributed to different disease prevalence geographically.…”

Correlation of apparent diffusion coefficient value with prognostic parameters of endometrioid carcinoma

“…Higher‐grade tumors generally have higher cellular density and therefore would be anticipated to show a lower ADC . However, most previous investigations have found no significant correlation between mean ADC and tumor grade . Tamai et al reported a significant difference between mean ADCs of grade 1 and grade 3 tumors, but considerable overlap was present in that study and precise estimation of histological grade based on mean ADC still seems difficult.…”

A literature review of the association between diffusion-weighted MRI derived apparent diffusion coefficient and tumour aggressiveness in pelvic cancer

“…Another study showed that although in comparison to benign endometrial pathology (e.g. benign polyps and hyperplasia) ADC values of endometrial cancer were significantly lower [29], no significant differences were detectable between different histological grades. These conflicting results might be explained due to the small sample sizes and necessitate the use of larger, prospectively powered studies.…”