The diagnostic performance of ADC value for tumor grade, deep myometrial invasion and lymphovascular space invasion in endometrial cancer: a meta-analysis

BACKGROUND

Disputes exist regarding whether the apparent diffusion coefficient (ADC) can differentiate the tumor grade, deep myometrial invasion and lymphovascular space invasion (LVSI) in endometrial cancer. The aim of this review was to assess the diagnostic performance of the ADC value in endometrial cancer.

MATERIAL AND METHODS

The PubMed, Web of Science, Embase and Cochrane Library databases were searched for studies that used the ADC value to assess tumor grade, deep myometrial invasion and LVSI in endometrial cancer. We used forest plots to analyze the heterogeneity and generate the pooled sensitivity (SEN) and specificity (SPE). We used summary receiver operating characteristic (SROC) curves to work out the area under the SROC curve (AUC). Likelihood ratios (LRs) were also obtained.

RESULTS

Of the 460 identified studies, 11 studies met our inclusion criteria and were included. Overall, nine studies (491 patients) aimed at differentiating high tumor grade had a pooled SEN, SPE and AUC of 77%, 73% and 81%, respectively; three studies (181 patients) for differentiating deep myometrial invasion had a pooled SEN, SPE and AUC of 71%, 67% and 77%, respectively; and two studies (106 patients) for differentiating LVSI had a pooled SEN and SPE of 66% and 74%, respectively. The positive and negative LRs were 2.77 and 0.35 for the tumor grade, 2.08 and 0.45 for deep myometrial invasion, and 2.48 and 0.45 for LVSI.

CONCLUSION

This meta-analysis showed that the ADC value had a moderate diagnostic performance for the tumor grade, deep myometrial invasion and LVSI in endometrial cancer.

Amide proton transfer imaging to evaluate the grading of squamous cell carcinoma of the cervix: A comparative study using 18 F FDG PET

BACKGROUND

Amide proton transfer (APT) imaging has shown great potential value in the diagnosis of cancer, but has yet not been applied in cervical carcinoma patients.

PURPOSE

To investigate the utility of APT imaging in estimating histologic grades of squamous cell carcinoma of the cervix (SCCC), compared with the standardized uptake value (SUV).

STUDY TYPE

Prospective.

POPULATION

Thirty-one patients with SCCC (median age 51 years) were included.

FIELD STRENGTH/SEQUENCE

Ingenia 3.0 T CX, Axial T₁ -weighted imaging (T₁ WI), Axial T₂ WI, 3D turbo spin echo sequence for APT imaging.

ASSESSMENT

Patient pathology was confirmed by surgery and the patients were divided into three groups based on histologic grades: Grade 1 (n = 9), Grade 2 (n = 12), and Grade 3 (n = 10). The APT signal intensity (APT SI), maximum SUV (SUV_max ) and mean SUV (SUV_mean ) for each grade were assessed by experienced radiologists in a blinded manner.

STATISTICAL TESTS

The obtained parameters were compared by one-way analysis of variance with Tukey honest significant difference post-hoc test. The correlations between the parameters and histologic grades were analyzed by Spearman's correlation coefficient. The Pearson correlation coefficients of the APT SI with the SUV_max and SUV_mean were also calculated.

RESULTS

The APT SIs for the three grades were significantly different (P = 0.0002). The APT SIs of Grade 2 and Grade 3 had significant differences (P = 0.009). The Spearman correlation coefficients for the correlations between the parameters and histological grade were as follows: APT SI: 0.684 (P = 0.00002), SUV_max : 0.318 (P = 0.082), and SUV_mean : 0.261 (P = 0.157). The Pearson correlation coefficients of the APT SI with the SUV_max and SUV_mean were 0.108 (P = 0.564) and 0.178 (P = 0.337), respectively.

DATA CONCLUSION

The APT SI was positively correlated with the SCCC grades. APT imaging maybe a promising method for predicting SCCC histologic grades.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:261-268.

Identifying Recurrent Malignant Glioma after Treatment Using Amide Proton Transfer-Weighted MR Imaging: A Validation Study with Image-Guided Stereotactic Biopsy

PURPOSE

To quantify the accuracy of amide proton transfer-weighted (APTw) MRI for identifying active glioma after treatment via radiographically guided stereotactic tissue validation.Experimental Design: Twenty-one patients who were referred for surgery for MRI features concerning for tumor progression versus treatment effect underwent preoperative APTw imaging. Stereotactic biopsy samples were taken from regions of interest with varying APTw signal intensities. The relationship between final clinical pathology and the histopathology of each of the 64 specimens was analyzed relative to APTw results. Analysis of confirmed recurrent tumor or treatment effect tissue was used to perform ROC analysis.

RESULTS

Eighteen of 21 patients had recurrent tumor, and 3 had treatment effect on clinical pathology. In 12 patients, there were multiple histopathologic assignments confirmed within the same tumor. Of the 64 total specimens, 20 specimens were active glioma, 27 mixed active and quiescent glioma, and 17 quiescent/no identifiable tumor. APTw signal intensity and histopathologic assignment, cellularity, and proliferation index had significant positive correlations (R = 0.651, 0.580, and 0.458, respectively; all P < 0.001). ROC analysis with a 1.79% APTw intensity cutoff differentiated active from nonactive tumor (AUC of 0.881) with 85.1% sensitivity and 94.1% specificity. Analysis of clinical pathology showed the mean APTw intensity for each patient had 94.4% sensitivity and 100% positive predictive value for identifying recurrent glioma at this cutoff.

CONCLUSIONS

APTw imaging hyperintensity may be a marker of active malignant glioma. It is able to distinguish between regions of heterogeneous abnormality on anatomic brain MRI with high sensitivity and specificity.

A Preliminary Report Requiring Continuation of Research to Confirm Fallopian Tube Adenocarcinoma: A Non-Experimental, Non-Randomized, Cross-Sectional Study

Background

Transvaginal ultrasound has fair characteristics, and pathology is an invasive technique for fallopian tube tumor diagnosis. Magnetic resonance images have better intra- and inter-observer reliabilities for detection of primary fallopian tube malignant tumor(s) than the other diagnostic modalities. The purpose of this study was to investigate parameters of different types of magnetic resonance images for women with fallopian tube adenocarcinoma and to compare these parameters with the FIGO grading system to improve the accuracy of diagnosis and prognosis.

Material/Methods

A total of 121 women who had clinically-proven fallopian tube adenocarcinoma were included in this cross-sectional study. A 3.0 T magnetic resonance images system was used for spin-lattice relaxation-weighted (T1WI), spin-spin relaxation-weighted (T2WI), diffusion-weighted, (DWI), and apparent diffusion coefficient (ADC) images. ANOVA following Tukey post hoc tests and Spearman rank correlation were performed at 99% confidence level.

Results

Axial T1WI, axial T2WI, and axial DWI, were provided low, intermediate, and high fluid signal intensity, respectively, for a tumor. Sagittal T1WI showed contrast uptake by the mass with necrosis. Sagittal T2WI showed a solid mass with well-defined walls. Sagittal DWI showed restriction to diffusion. ADC values were significantly higher for FIGO grade 1 women than for FIGO grade 3 women (p<0.0001, q=16.591). The Spearman correlation coefficient was 0.1012 between mean ADC and FIGO grading.

Conclusions

We recommend that magnetic resonance images be included in the FIGO guideline for grading of malignancies in the female genital tract.