Preoperative diffusion-weighted magnetic resonance imaging and intraoperative frozen sections for predicting the tumor grade in endometrioid endometrial cancer

// Tomohito Tanaka 1, 4 , Yoshito Terai 1, 4 , Satoe Fujiwara 1 , Yoshimichi Tanaka 1 , Hiroshi Sasaki 1 , Satoshi Tsunetoh 1 , Kazuhiro Yamamoto 2, 5 , Takashi Yamada 3 , Yoshifumi Narumi 2 and Masahide Ohmichi 1 1 Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Japan 2 Department of Obstetrics and Radiology, Osaka Medical College, Takatsuki, Japan 3 Department of Obstetrics and Pathology, Osaka Medical College, Takatsuki, Japan 4 Department of Obstetrics and Gynecology, First Towakai Hospital, Takatsuki, Japan 5 Department of Obstetrics and Radiology, First Towakai Hospital, Takatsuki, Japan Correspondence to: Tomohito Tanaka, email: gyn123@osaka-med.ac.jp Keywords: endometrial cancer; diffusion weighted image; apparent diffusion coefficient; frozen section; grade Received: February 28, 2018      Accepted: November 03, 2018      Published: November 27, 2018 ABSTRACT 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 ADC mean values for predicting high-grade tumors resulted in 743×10 -6 mm 2 /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.