Abstract
PurposeTo evaluate the feasibility of apparent diffusion coefficient (ADC) value combined with texture analysis (TA) in preoperatively predicting the expression levels of Ki-67 and p53 in endometrial carcinoma (EC) patients.MethodsClinical, pathological and MRI findings of 110 EC patients were analyzed retrospectively. The expression levels of Ki-67 and p53 in EC tissues were detected by immunohistochemistry. ADC value was calculated, and three-dimensional (3D) texture features were measured on T2-weighted images (T2WI), diffusion-weighted images (DWI), and contrast-enhanced T1-weighted images (CE-T1WI). The univariate and multivariate logistic regression and cross-validations were used for the selection of texture features. The receiver operating characteristic (ROC) curve was performed to estimate the diagnostic efficiency of prediction model by the area under the curve (AUC) in the training and validation cohorts.ResultsSignificant differences of the ADC values were found in predicting Ki-67 and p53 (P=0.039, P=0.007). The AUC of the ADC value in predicting the expression levels of Ki-67 and p53 were 0.698, 0.853 and 0.626, 0.702 in the training and validation cohorts. The AUC of the TA model based on T2WI, DWI, CE-T1WI, and ADC value combined with T2WI + DWI + CE-T1WI in the training and validation cohorts for predicting the expression of Ki-67 were 0.741, 0.765, 0.733, 0.922 and 0.688, 0.691, 0.651, 0.938, respectively, and for predicting the expression of p53 were 0.763, 0.805, 0.781, 0.901 and 0.796, 0.713, 0.657, 0.922, respectively.ConclusionADC values combined with TA are beneficial for predicting the expression levels of Ki-67 and p53 in EC patients before surgery, and they provide higher auxiliary diagnostic values for clinical application.
Highlights
Endometrial carcinoma (EC) is one of the most common malignancies of the female reproductive system worldwide [1], and the morbidity and mortality of EC have been rising with a trend towards a younger age [2]
The inclusion criteria were as follows: (a) histologic confirmation of primary EC according to the World Health Organization criteria; (b) no history of preoperative treatment; (c) preoperative available T2-weighted images (T2WI), DWI and CE-T1-weighted images (T1WI) images; (d) available Ki-67 and p53 expression based on immunohistochemical detection; (e) lesion that could be measured and segmented on MRI
The AUC of the TA model based on T2WI, DWI, CET1WI, and ADC value combined with T2WI + DWI + CE-T1WI in the training and validation cohorts for predicting the expression of Ki-67 were 0.741, 0.765, 0.733, 0.922 and 0.688, 0.691, 0.651, 0.938, respectively, and for predicting the expression of p53 were 0.763, 0.805, 0.781, 0.901 and 0.796, 0.713, 0.657, 0.922, respectively, with great performance
Summary
Endometrial carcinoma (EC) is one of the most common malignancies of the female reproductive system worldwide [1], and the morbidity and mortality of EC have been rising with a trend towards a younger age [2]. It has been suggested that the occurrence and development of EC are related to estrogen levels and to the proliferation and apoptosis of tumor cells [3]. A necessary condition for normal functioning of the body is to maintain the dynamic balance between cell proliferation and apoptosis [4, 5]. If this balance is broken, it will promote the occurrence of tumors. Higher values of Ki-67 indicate increased malignancy and invasiveness of tumours [7]. Higher values of Ki-67 indicate increased malignancy and invasiveness of tumours [7]. p53 is an important tumor suppressor gene that controls the initiation of the cell cycle, regulates cell division, inhibits cell growth, regulates transcription, and induces apoptosis [8]
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