Research Papers:

Evaluation and validation of the diagnostic value of the apparent diffusion coefficient for differentiating early-stage endometrial carcinomas from benign mimickers at 3T MRI

Xue Wang, Yu Zhao, Yumin Hu, Yongjin Zhou, Xinjian Ye, Kun Liu, Guanghui Bai, Anna Guo, Meimei Du, Lezhen Jiang, Jinhong Wang and Zhihan Yan _

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Oncotarget. 2017; 8:46390-46397. https://doi.org/10.18632/oncotarget.18553

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Xue Wang1,*, Yu Zhao2,*, Yumin Hu1, Yongjin Zhou1, Xinjian Ye1, Kun Liu1, Guanghui Bai1, Anna Guo1, Meimei Du1, Lezhen Jiang1, Jinhong Wang3,* and Zhihan Yan1,*

1Department of Radiology, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou 325027, China

2Department of Gynecology and Obstetrics, The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, Wenzhou 325027, China

3Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

*These authors contributed equally to this work

Correspondence to:

Zhihan Yan, email: [email protected]

Jinhong Wang, email: [email protected]

Keywords: magnetic resonance imaging, endometrial lesions, diffusion-weighted imaging, apparent diffusion coefficient, diagnostic accuracy

Received: January 16, 2017     Accepted: June 04, 2017     Published: June 16, 2017


Previous researchers obtained various apparent diffusion coefficient (ADC) cutoff values to differentiate endometrial carcinoma from benign mimickers with 1.5T magnetic resonance imaging (MRI). Few studies have used 3T MRI or validated the effectiveness of these cutoff ADC values prospectively. This study was designed in two stages to obtain a cutoff ADC value at 3T MRI and to validate prospectively the role of the ADC value. First, we conducted a retrospective study of 60 patients to evaluate the diagnostic value of ADC by obtain a theoretical cutoff ADC value for differentiating between benign and malignant endometrial lesions. Student’s t test revealed that ADC values for stage I endometrial carcinomas were significantly lower than those for benign lesions. The area under the curve value of the receiver operating characteristic curve was 0.993, and the cutoff ADC value was 0.98 × 10-3 mm2/s. The sensitivity, specificity, and overall accuracy of diagnosing stage I endometrial carcinoma were 100%, 97.1%, and 98.3%, respectively. Second, we conducted a prospective study of 26 patients to validate the use of the cutoff ADC value obtained in the study’s first stage. The sensitivity, specificity, and overall accuracy for differentiating malignant from benign endometrial lesions based on the cutoff ADC value obtained earlier were as follows: radiologist 1 attained 86.67%, 100.0%, and 92.31%, respectively; radiologist 2 attained 86.67%, 91.0%, and 88.5%, respectively. Our results suggest that ADC values could be a potential biomarker for use as a quantitative and qualitative tool for differentiating between early-stage endometrial carcinomas and benign mimickers.

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