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Apparent diffusion coefficient values of lymph nodes in endometrial cancer: can they predict lymph node metastases? -
Ana Teresa Teixeira1, Rita Camelo2, Filipe Barros Alves2
1Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal. anateresa.mteixeira@gmail.com.
Purpose:
To evaluate the Apparent Diffusion Coefficient (ADC) values of the primary tumor and lymph nodes in endometrial cancer, correlating them with pathological results, to determine their predictive accuracy for lymph node metastases.
Methods:
A retrospective observational study was conducted on patients with endometrial carcinoma who underwent preoperative MRI staging, surgical treatment and postoperative pathological analysis in our institution from 2014 to 2022. The analyzed variables included were, among others: the mean, minimum and maximum ADC values of the primary tumor and lymph node(s); the variation of the mean, minimum and maximum ADC values between the lymph node(s) and the tumor; the short axis of the lymph node(s); and the pathological evaluation of the lymph node(s) - metastatic vs. non-metastatic involvement. A multivariable analysis was performed using R (version 4.2.2), with metastatic involvement of the lymph node(s) as the outcome. The inter-rater reliability for the ADC values' measurements was assessed using intraclass correlation coefficient (ICC).
Results:
The study's cohort included 74 patients, comprising a total of 233 lymph nodes. A mean ADC value variation ≤ 0.13 between the lymph nodes and the primary tumor and a lymph node short axis ≥ 9 mm were significantly associated with lymph node metastases, with odds ratios of 10.91 (p < 0.001) and 18.13 (p < 0.001), respectively. ICC values for ADC measurements ranged from 0.81 to 0.96, indicating good inter-rater reliability.
Conclusion:
Along with the lymph node short axis, the mean ADC value variation has potential to predict lymph node metastases in patients with endometrial cancer.
