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Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2–IIA cervical cancer

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Abstract

Objective

To investigate the value of diffusion-weighted imaging (DWI) in evaluating parametrial invasion (PMI) in stage IA2–IIA cervical cancer.

Methods

A total of 117 patients with stage IA2–IIA cervical cancer who underwent preoperative MRI and radical hysterectomy were included in this study. Preoperative clinical variables and MRI variables were analysed and compared between the groups with and without pathologically proven PMI.

Results

All variables except age were significantly different between patients with and without pathologic PMI (P < 0.05). All variables except squamous cell carcinoma (SCC) antigen were also significantly correlated with pathologic PMI on univariate analysis (P < 0.05). Multivariate analysis indicated that PMI on MRI (P < 0.001) and tumour apparent diffusion coefficient (ADC) (P = 0.029) were independent predictors of pathologic PMI. Area under the curve of PMI on MRI increased significantly from 0.793 to 0.872 when combined with tumour ADC (P = 0.002). When PMI on MRI was further stratified by tumour ADC, the false negative rate was 2.0 % (1/49).

Conclusion

In stage IA2–IIA cervical cancer, tumour ADC and PMI on MRI seem to be independent predictors of pathologic PMI. Combining the two predictors improved the diagnostic performance of identifying patients at low risk of pathologic PMI.

Key points

• Accurate PMI prediction is essential for appropriate treatment planning

• Tumour ADC appears to be an independent predictor of pathologic PMI

• Adding DWI to MRI improves accuracy for identifying low-risk patients for PMI

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

CI:

Confidence interval

DWI:

Diffusion-weighted imaging

FIGO:

International Federation of Gynecology and Obstetrics

FOV:

Field of view

LN:

Lymph node

MRI:

Magnetic resonance imaging

OR:

Odds ratio

PMI:

Parametrial invasion

ROC:

Receiver operating characteristics

ROI:

Region of interest

SCC:

Squamous cell carcinoma

T2WI:

T2-weighted imaging

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Acknowledgements

The scientific guarantor of this publication is Chan Kyo Kim, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study did not receive any funds. The institutional review board of our hospital approved this retrospective study. The requirement for informed consent was waived due to the retrospective nature of the study. Approval from the institutional animal care committee was not required because this study was on human subjects. None of the study subjects or cohorts have been previously reported in any studies. All co-authors have approved the publication. The responsible authorities and guarantor at the institute have carried out the work. All material submitted (including intellectual property and illustration elements) originated from the authors. The authors take responsibility for accuracy and completeness of references and copyright permissions. Sookyoung Woo, PhD kindly provided statistical advice for this manuscript. The authors thank Sookyoung Woo, PhD, at Samsung Biomedical Research Institute for help in statistical consultation. Methodology: retrospective, diagnostic or prognostic study, performed at one institution

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Republic of Korea, 135-710

    Jung Jae Park, Chan Kyo Kim, Sung Yoon Park & Byung Kwan Park

  2. Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Bohyun Kim

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  1. Jung Jae Park
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  2. Chan Kyo Kim
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Correspondence to Chan Kyo Kim.

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Park, J.J., Kim, C.K., Park, S.Y. et al. Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2–IIA cervical cancer. Eur Radiol 24, 1081–1088 (2014). https://doi.org/10.1007/s00330-014-3109-x

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  • DOI: https://doi.org/10.1007/s00330-014-3109-x

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