Prediction of histological grade of endometrial cancer by means of MRI

• Published in: European journal of radiology Vol. 103; pp. 44 - 50
• Main Authors: Bonatti, Matteo, Pedrinolla, Beatrice, Cybulski, Adam Jerzy, Lombardo, Fabio, Negri, Giovanni, Messini, Sergio, Tagliaferri, Tiziana, Manfredi, Riccardo, Bonatti, Giampietro
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.06.2018
• Subjects: Adult; Aged; Aged, 80 and over; Diffusion magnetic resonance imaging; Endometrial neoplasms; Endometrial Neoplasms - diagnostic imaging; Endometrial Neoplasms - pathology; Endometrium - diagnostic imaging; Endometrium - pathology; Female; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Middle Aged; Neoplasm Grading; Retrospective Studies; Sensitivity and Specificity; Uterus; ADC; MRI; Diffusion magnetic resonance imaging; ROC; Neoplasm grading; Uterus; Magnetic resonance imaging; N/U; T2-WI; CET1-WI; DWI; Endometrial neoplasms; EC
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2018.04.008

•Pre-operative biopsy under-grades endometrial cancer in 18.9% of the cases.•Deep myometrial infiltration is significantly associated with high grade endometrial cancer.•Neoplasm/uterus volume ratio is significantly higher in high grade endometrial cancer.•ADC histogram analysis does not allow to identify high grade endometrial cancer. To evaluate the ability of MRI in predicting histological grade of endometrial cancer (EC). IRB-approved retrospective study; requirement for informed consent was waived. 90 patients with histologically proven EC who underwent preoperative MRI and surgery at our Institution between Sept2011 and Nov2016 were included. Myometrial invasion (</>50%) was assessed. Neoplasm and uterus volumes were estimated according to the ellipsoid formula; neoplasm/uterus volume ratio (N/U) was calculated. ADC maps were generated and histogram analysis was performed using commercially available software. MRI parameters were compared with the definitive histological grade (G1 = 28 patients, G2 = 29, G3 = 33) using ANOVA and Tukey-Kramer tests. Deep myometrial invasion was significantly more frequent in G2-G3 lesions than in G1 ones (p < 0,005). N/U ratio was significantly higher for high-grade neoplasms (mean 0,08 for G1, 0,16 for G2 and 0,21 in G3; P = 0,002 for G1 vs. G2-G3); a cut off value of 0,13 enabled to distinguish G1 from G2-G3 lesions with 50% sensibility and 89% specificity. ADC values didn’t show any statistically significant correlation with tumour grade. N/U ratio >0.13 and deep myometrial invasion are significantly correlated with high grade EC, whereas ADC values are not useful for predicting EC grade.