Preoperative diffusion-weighted magnetic resonance imaging and intraoperative frozen sections for predicting the tumor grade in endometrioid endometrial cancer
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Tomohito Tanaka1,4, Yoshito Terai1,4, Satoe Fujiwara1, Yoshimichi Tanaka1, Hiroshi Sasaki1, Satoshi Tsunetoh1, Kazuhiro Yamamoto2,5, Takashi Yamada3, Yoshifumi Narumi2 and Masahide Ohmichi1
1Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Japan
2Department of Obstetrics and Radiology, Osaka Medical College, Takatsuki, Japan
3Department of Obstetrics and Pathology, Osaka Medical College, Takatsuki, Japan
4Department of Obstetrics and Gynecology, First Towakai Hospital, Takatsuki, Japan
5Department of Obstetrics and Radiology, First Towakai Hospital, Takatsuki, Japan
Tomohito Tanaka, email: [email protected]
Keywords: endometrial cancer; diffusion weighted image; apparent diffusion coefficient; frozen section; grade
Received: February 28, 2018 Accepted: November 03, 2018 Published: November 27, 2018
Objective: The 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.
Methods: Ninety-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.
Results: Among 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.
Conclusion: A 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.
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