Abstract
Purpose:To investigate the feasibility of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values in differentiating endometrial cancer from benign endometrial lesions in postmenopausal patients with vaginal bleeding and endometrial thickening and to predict the depth of myometrial invasion in endometrial cancer.Materials and Methods:Postmenopausal patients with vaginal bleeding and endometrial thickening were enrolled in this prospective study. T2-weighted, pre- and postcontrast T1-weighted and diffusion-weighted images were obtained. The ADC values of all the patients with endometrial pathologies were recorded. The staging accuracies of DWI and postcontrast T1-weighted images in the assessment of myometrial invasion were evaluated in histopathologically proven endometrial cancer patients.Results:Fifty-two patients (mean age: 57 ± 10, range: 41–79) were enrolled in the study. Thirty-eight of the lesions were benign (27 as hyperplasia and endometritis; 11 as polyps). Fourteen of the 52 endometrial lesions were pathologically proven as cancers and underwent hysterectomy, and all the specimens were reported as endometrioid adenocarcinomas. The mean ADC value (10–3 mm2/second) of cancer (0.88 ± 0.10) was significantly lower than that of benign lesions (1.78 ± 0.27, p = 0,001). There was no significant difference between ADC values of endometrial tissue in patients with FIGO stage 1A (0.87 ± 0.11, n = 9) and FIGO stage 1B (0.91 ± 0.07, n = 5). The staging accuracy was 92.9 per cent (13/14) for DWI and 85.7 per cent (12/14) for postcontrast T1-weighted images.Conclusion:ADC values allow benign endometrial lesions to be differentiated from endometrial cancer in postmenopausal patients but do not correlate with the depth of myometrial invasion and histological tumor grading.
Highlights
Endometrial carcinoma is the most common gynecologic malignancy [1]
We aimed to investigate the feasibility of diffusion-weighted magnetic resonance imaging (DWI) in differentiating endometrial cancer from benign endometrial lesions in postmenopausal patients with vaginal bleeding and endometrial thickening before using invasive diagnostic methods and to evaluate the myometrial invasion in the endometrial cancer group
DWI demonstrated the degree of myometrial invasion in endometrial cancer more accurately compared to conventional Magnetic resonance imaging (MRI) sequences
Summary
Endometrial carcinoma is the most common gynecologic malignancy [1]. Endometrial carcinoma is usually characterized by endometrial thickening or an endometrial mass. Some benign endometrial lesions such as endometrial hyperplasia and endometrial polyps may cause uterine bleeding and endometrial thickening or a focal mass [3]. Those pathologies should be discriminated to navigate the treatment process. Endometrial biopsy or dilatation and curettage (D&C) may not be possible in postmenopausal patients due to endometrial atrophy, endometrial adhesions, or the requirement of general anesthesia
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