Differentiation of metastatic from non-metastatic lymph nodes in patients with uterine cervical cancer using diffusion-weighted imaging

Background Lymph nodes metastasis is an important factor affecting survival rate and recurrence in cervical cancer patients. Currently, diagnosis of metastatic lymph nodes is mainly based on morphological changes on imaging. However, it is difficult to differentiate normal-sized metastatic lymph nodes with short axis of 5-10mm. Purpose To assess the diagnostic value of apparent diffusion coefficient (ADC) for discriminating different-sized metastatic lymph nodes in patients with cervical cancers. Material and Methods Pathologically confirmed cervical cancer patients were documented from January 2013 to July 2018 in our hospital. A total of 133 patients who underwent conventional MRI and diffusion-weighted imaging with complete pathology were finally enrolled. A total of 157 lymph nodes were harvested and analyzed. All lymph nodes were divided into three groups according to pathology and their short axis (S) measured on axial T2-weighted imaging: normal-sized (5 mm<S<10 mm) benign lymph nodes (Group 1); normal-sized (5 mm<S<10 mm) metastatic lymph nodes (Group 2); enlarged (S≥10 mm) metastatic lymph nodes (Group 3). Mean ADC (ADCmean), minimum ADC (ADCmin), and maximum ADC (ADCmax) values of lymph nodes were analyzed and compared among the three groups. Results ADCmean of Groups 1 and 2 were significantly larger than those of Group 3 ( P<0.001, P=0.005, respectively). ADCmin of Group 1 were significantly larger than those of Groups 2 and 3 ( P<0.001, P<0.001, respectively). ADCmax was not statistically different among the three groups. ADCmean had the relatively highest area under the curve (AUC) of 0.644 for assessing enlarged metastatic lymph nodes, with a sensitivity of 64.4% and specificity of 67.9%. ADCmin had the highest AUC of 0.758 for assessing normal-sized metastatic lymph nodes, with a sensitivity of 84.7% and specificity of 60.7%. Conclusion Diffusion-weighted imaging can be used to differentiate enlarged metastatic lymph nodes from benign lymph nodes, and ADCmin can be further used to identify micro-metastasis in normal-sized lymph nodes.

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Diffusion-weighted magnetic resonance imaging of primary cervical cancer in the detection of sub-centimetre metastatic lymph nodes

Cancer Imaging ◽

10.1186/s40644-020-00303-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jose Angelo Udal Perucho ◽

Keith Wan Hang Chiu ◽

Esther Man Fung Wong ◽

Ka Yu Tse ◽

Mandy Man Yee Chu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Cancer ◽

Magnetic Resonance ◽

Lymph Nodes ◽

Resonance Imaging ◽

Metastatic Lymph Nodes ◽

Diffusion Weighted ◽

Metastatic Lymph ◽

Weighted Magnetic Resonance Imaging

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Value of MRI and diffusion weighted imaging in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer

British Journal of Radiology ◽

10.1259/bjr.20200203 ◽

2020 ◽

pp. 20200203

Author(s):

Qingling Song ◽

Yanyan Yu ◽

Xiaomiao Zhang ◽

Yanmei Zhu ◽

Yahong Luo ◽

...

Keyword(s):

Cervical Cancer ◽

Decision Tree ◽

Lymph Nodes ◽

Diffusion Weighted Imaging ◽

Short Axis ◽

Metastatic Lymph Nodes ◽

Pelvic Lymph Nodes ◽

Metastatic Lymph ◽

And Diffusion ◽

Lymph Nodes Metastases

Objectives: To investigate the value of conventional magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer. Methods: 102 patients with cervical cancer who underwent MRI and DWI scan were included. 137 lymph nodes were analyzed, including 44 metastatic lymph nodes(MLNs) and 93 non-metastatic lymph nodes(non-MLNs).The morphology and apparent diffusion coefficient (ADC) value of lymph nodes were measured including short-axis diameter (DS), long-axis diameter (DL), ratio of short to long-axis diameter (DR), fatty hilum, asymmetry, ADCmax, ADCmean and ADCmin. The Mann-Whitney U test, independent sample t test and Chi-square test were employed to compare the difference of all criteria between MLNs and non-MLNs. Logistic regression and decision tree were used to develop the combined diagnostic model. ROC analyses were used to evaluate the diagnostic performance. Results: The DS and DR of MLNs were significantly higher than those of non-MLNs (p < 0.05), the ADCmax, ADCmean and ADCmin of MLNs were significantly lower than those of non-MLNs (p < 0.05). Presence of fatty hilum and asymmetric lymph nodes between MLNs and non-MLNs were significantly different (p＜0.05). Combined measurement of ADCmin, DS and DR had the highest AUC 0.937 with 90.9% sensitivity and 87.1% specificity. The accuracy of decision tree was 88.3%. Conclusion: MRI with DWI had potential in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer. The combined evaluation of DS, DR and ADCmin of lymph nodes and decision tree of the combined measure showed better diagnostic performances than sole criteria. Advances in knowledge: The short-axis diameter, ratio of short to long-axis diameter and ADCmin of lymph nodes have moderate value in the diagnosis of the metastases of the normal-sized lymph nodes for the patient with cervical cancer as the sole indices. The combined evaluation of DS, DR and ADCmin is much more valuable in the detection of metastatic lymph nodes.

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