Abstract
ObjectiveThe histological tumor grade is a strong predictor of nodal metastasis in endometrial cancer; as such, an accurate pre- or intraoperative diagnosis is important for performing lymphadenectomy.MethodsNinety-one patients with endometrioid endometrial cancer were imaged on DW-MRI with the apparent diffusion coefficient (ADC) calculated and a frozen section (FS) diagnosis made before and at hysterectomy. The diagnostic accuracy for predicting the tumor grade for diffusion weighted magnetic resonance inaging (DW-MRI) and the FS diagnosis compared to the ultimate histologic status was analyzed.ResultsAmong 91 patients with endometrioid endometrial cancer, high-grade (endometrioid G3) tumors had lower ADC values than low-grade (endometrioid G1/2) tumors. The cut-off of the mean ADCmean values for predicting high-grade tumors resulted in 743×10-6 mm2/sec according to the receiver operating characteristic curve. The true positive rates of ADC values and FSs for the prediction of high-grade tumors did not differ to a statistically significant extent (73.3% vs. 66.7%, p=0.7), however, the true negative rate of ADC values for the prediction of low-grade tumors was significantly lower than that of the FSs (64.5% vs. 98.7%, p=0.01). The kappa statistics of ADC values and FSs were 0.23 and 0.73, respectively. Of note, all five patients with high-grade tumors for whom intraoperative FSs indicated low-grade tumors were predicted to have high-grade tumors on preoperative DW-MRI.ConclusionA FS diagnosis is more suitable for predicting high-grade tumors than DW-MRI; however, physicians should pay close attention to tumors with low ADC values on preoperative DW-MRI.
Highlights
The histological tumor grade is an important factor for predicting lymph node metastasis and the prognosis in endometrial cancer
The cut-off of the mean ADCmean values for predicting high-grade tumors resulted in 743×10-6 mm2/sec according to the receiver operating characteristic curve
A frozen section (FS) diagnosis is more suitable for predicting high-grade tumors than Diffusion-weighted Magnetic resonance imaging (MRI) (DW-MRI); physicians should pay close attention to tumors with low apparent diffusion coefficient (ADC) values on preoperative DW-MRI
Summary
The histological tumor grade is an important factor for predicting lymph node metastasis and the prognosis in endometrial cancer. Pelvic lymph node dissection (PLND) remains an important surgical procedure for treating endometrial cancer. This procedure is necessary to obtain correct staging and has resulted in a favorable prognosis, especially in patients with high-risk endometrial cancer [2,3,4,5,6,7,8,9,10], it may not be needed for low-risk cases, including cases involving low-grade tumors and cases without myometrial invasion. The histological tumor grade is an important factor for making decisions regarding surgical procedures, including lymph node dissection. The tumor grade is determined with a preoperative biopsy [11]
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