Predicting tumor recurrence in patients with cervical carcinoma treated with definitive chemoradiotherapy: value of quantitative histogram analysis on diffusion-weighted MR images

Abstract

Background Further research is required for evaluating the use of ADC histogram analysis in more advanced stages of cervical cancer treated with definitive chemoradiotherapy (CRT). Purpose To investigate the utility of apparent diffusion coefficient (ADC) histogram derived from diffusion-weighted magnetic resonance images in cervical cancer patients treated with definitive CRT. Material and Methods The clinical and radiological data of 50 patients with histologically proven cervical squamous cell carcinoma treated with definitive CRT were retrospectively analyzed. The impact of clinicopathological factors and ADC histogram parameters on prognostic factors and treatment outcomes was assessed. Results The mean and median ADC values for the cohort were 1.043 ± 0.135 × 10 mm/s and 1.018 × 10 mm/s (range, 0.787-1.443 × 10 mm/s). The mean ADC was significantly lower for patients with advanced stage (≥IIB) or lymph node metastasis compared with patients with stage <IIB or no lymph node metastasis. The mean ADC, 75th percentile ADC (ADC75), 90th percentile ADC (ADC90), and 95th percentile ADC (ADC95) were significantly lower in patients with tumor recurrence compared with patients without recurrence. In multivariate analysis, tumor size, ADC75 and ADC95 were independent prognostic factors for both overall survival and disease-free survival. Conclusion ADC histogram parameters could be markers for disease recurrence and for predicting survival outcomes. ADC75, ADC90, and ADC95 of the primary tumor were significant predictors of disease recurrence in cervical cancer patients treated with definitive CRT.

Radiomics analysis of apparent diffusion coefficient in cervical cancer: A preliminary study on histological grade evaluation

“…To date, there have been a few studies assessing the utility of radiomics analysis of ADC in cervical cancer. Although these studies have been performed using a volumetric approach, they used different b values and different methods of region of interest (ROI) positioning; that is, ROI covered all voxels including cystic or necrotic areas within the tumor on all slices, or ROI contained solid components of tumor while avoiding hemorrhagic, necrotic, or cystic regions . Undoubtedly, volumetric tumor ADC delineation could provide a more comprehensive evaluation of underlying spatial heterogeneity; however, it is typically not widely available in routine clinical practice and is still time‐consuming .…”

“…15,16 Successful applications of this technique have been performed on oncologic DWI datasets. 15,17,18 To date, there have been a few studies [19][20][21][22][23][24][25] assessing the utility of radiomics analysis of ADC in cervical cancer. Although these studies have been performed using a volumetric approach, they used different b values and different methods of region of interest (ROI) positioning; that is, ROI covered all voxels including cystic or necrotic areas within the tumor on all slices, 23,24 or ROI contained solid components of tumor while avoiding hemorrhagic, necrotic, or cystic regions.…”

Whole‐lesion histogram analysis of the apparent diffusion coefficient: Evaluation of the correlation with subtypes of mucinous breast carcinoma

“…With this method, a volumetric ROI is positioned on the entire lesion over contiguous slices, and a histogram of ADC values reflecting the frequency of voxels is constructed. The approach of whole‐lesion histogram analysis eliminates the subjectivity inherent in the placement of a focal ROI, leading to better evaluation of heterogeneity …”

“…The approach of whole-lesion histogram analysis eliminates the subjectivity inherent in the placement of a focal ROI, leading to better evaluation of heterogeneity. [20][21][22][23] Recently, as personalized and targeted approaches to therapies are being pursued in the field of oncology, accurate tumor characterization is essential for selecting appropriate treatment. Diffusion-weighted imaging (DWI) can reflect the tissue microstructure, and emerging evidence suggests that quantitative ADC assessment may help to differentiate tumor subtypes.…”

Magnetic resonance imaging after external beam radiotherapy and concurrent chemotherapy for locally advanced cervical cancer helps to identify patients at risk of recurrence

“…Dynamic MRI permits evaluation of tumor response to chemoradiotherapy by analysis of tumor hypoxia and tumor interstitial pressure 21. Apparent diffusion coefficient has been identified as a good biomarker and modifications of its value during chemoradiotherapy have been associated with treatment response and survival 22. A prospective cohort study in which 92 women underwent PET examination 3 months after the end of the treatment found that residual tumor was significantly associated with decreased progression free survival 23.…”