Diffusion weighted imaging analysis and related biological behavior evaluation of 80 patients with endometrial stromal sarcoma

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Objective To determine the magnetic resonance diffusion weighted imaging (DWI) images of patients with endometrial stromal sarcoma (ESS) and to evaluate the related biological behavior. Methods Eighty ESS patients admitted to our hospital (January 2016 to December 2018) were included as the ESS group, and a contemporary cohort of 75 patients with uterine fibroids (UM) was included as the UM group. Conventional magnetic resonance imaging and DWI examination were performed in both groups, and the DWI apparent diffusion coefficient (ADC) values were calculated. According to ADC values, 80 ESS patients were divided into two subgroups: high ADC value group (n=40) and low ADC value group (n=40) . After the relevant examinations were completed, all patients received surgical treatment. The pathological specimens were taken to examine the expression levels of proliferating genes (Survivin, CyclinD1, Sp1 and Rb) and estrogen and progesterone receptors (SULT1E1, PRA, PRB, ERα and ERβ) . The ADC values in the ESS group and UM group were compared. The expression levels of proliferating genes and estrogen and progesterone receptors in the ESS group and UM group, and high ADC group and low ADC group were compared. Results (1) ADC value: The ADC value in the ESS group was lower than that in the UM group (P<0.05) . (2) Proliferating genes: The expression levels of Survivin, CyclinD1, Sp1 and Rb genes in the ESS group were higher than those in the UM group (P<0.05) . The expression levels of Survivin, CyclinD1, Sp1 and Rb genes in the high ADC group were lower than those in the low ADC group (P<0.05) . (3) Estrogen and progesterone receptors: The expression level of SULT1E1 receptor in the ESS group was lower than that in the UM group, whereas the expression levels of PRA, PRB, ERα and ERβ receptors were higher than those in the UM group (P<0.05) . The expression level of SULT1E1 receptor in the high ADC group was higher than that in the low ADC group, whereas the expression levels of PRA, PRB, ERα and ERβ receptors were lower than those in the low ADC group (P<0.05) . Conclusion DWI may differentiate benign and malignant lesions of uterus by ADC value. With the increase of malignant ESS malignancy, the ADC value shows a downward trend. Therefore, DWI examination favors accurate evaluation of the degree of ESS malignancy before surgery, so as to guide and develop individualized treatment and intervention protocol in the clinical settings. Key words: Endometrial stromal sarcoma; Magnetic resonance diffusion weighted imaging; Biological behavior; Proliferation gene expression; Estrogen and progesterone receptor expression