The Value Of The Apparent Diffusion Coefficient In Differentiating Type Ii From Type I Endometrial Carcinoma

Background Diagnostic type II endometrial carcinoma (EC) is considered more aggressive and has a poorer prognosis than type I EC; differentiation between them is helpful for preoperative clinical decision-making. However, the diagnostic value of the apparent diffusion coefficient (ADC) in differentiating them remains unclear. Purpose To investigate the value of ADC in differentiating type II EC from type I EC. Material and Methods Ninety-four patients with EC who underwent diffusion-weighted imaging (DWI) were retrospectively included and divided into type I and type II subgroups, based on the postoperative pathologic results. We analyzed the clinical characteristics, conventional magnetic resonance imaging manifestations, and ADC mean values (ADC(mean)), ADC minimum values (ADC(min)), and ADC max values (ADC(max)). Receiver operating characteristic (ROC) curve analysis was further used to assess the predictive performance. Results The ADC(mean), ADC(min), and tumor size differed significantly between the two subtypes. The area under the ROC curve (AUC) for ADC(mean)and ADC(min)was 0.787 (95% confidence interval [CI] = 0.692-0.88) and 0.835 (95% CI = 0.751-0.919) for predicting type II EC, respectively. The optimal cut-off value of ADC(mean)for prediction was 0.757 x 10(-3)mm(2)/s with a sensitivity of 91%, a specificity of 58%, and an accuracy of 74%, while for ADC(min)was 0.637 x 10(-3)mm(2)/s with a sensitivity of 82%, a specificity of 73%, and an accuracy of 75%. Conclusion EC with lower ADC(mean)and ADC(min)values derived from DWI, and a larger size, are indicative of type II EC.