Quantitative kinetic parameters of primary tumor can be used to predict pelvic lymph node metastasis in early-stage cerv
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PELVIS
Quantitative kinetic parameters of primary tumor can be used to predict pelvic lymph node metastasis in early‑stage cervical cancer Zhiqiang Bai1 · Jie Shi2 · Zehong Yang1 · Weike Zeng1 · Huijun Hu1 · Jinglian Zhong1 · Xiaohui Duan1 · Xinmin Wang3 · Jun Shen1 Received: 4 July 2020 / Revised: 26 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To investigate the role of kinetic parameters of primary tumor derived from dynamic contrast-enhanced MRI (DCE-MRI) in predicting pelvic lymph node metastasis (PLNM) in patients with cervical cancer. Methods 66 women with newly diagnosed cervical cancer were included between July 2017 and August 2019. All patients had a FIGO stage IB-IIA cancer and treated with hysterectomy and bilateral lymphadenectomy. Kinetic parameters of the primary tumor were derived from DCE-MRI data. The tumor diameter, ADC value, kinetic parameters, and nodal short-axis diameter were compared between patients with or without PLNM. Logistic regression analysis was used to determine the independent predictors for PLNM and receiver operator characteristic curve was used to evaluate the predictive performance. Results There were 20 patients with PLNM and 46 patients without PLNM. Tumor diameter, the efflux rate constant (Kep), and nodal short-axis diameter were significantly higher in patients with PLNM (P < 0.01). Multivariate logistic regression analysis showed that Kep and short-axis diameter were independent predictors for PLNM. Combining Kep and nodal short-axis diameter yielded the highest area under the curve (AUC) of 0.839. Combined with Kep, the sensitivity, specificity, negative predictive value, and positive predictive value of nodal short-axis diameter increased from 0.500, 0.957, 0.815, and 0.833 to 0.600, 0.978, 0.923, and 0.849, respectively. With 1.113 m in−1 as threshold, the sensitivity and specificity values of Kep in predicting PLNM in patients with normal-sized lymph nodes were 0.909 and 0.667, respectively. Conclusions Kep of primary tumor can be used as a surrogate marker to predict PLNM in cervical cancer. Keywords Uterine cervical neoplasms · Lymphatic metastasis · Magnetic resonance imaging · Dynamic contrast-enhanced MRI · Diagnostic imaging
Introduction
Zhiqiang Bai and Jie Shi contributed equally to this work. * Xinmin Wang [email protected] * Jun Shen [email protected] 1
Department of Radiology, Sun Yat‑Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
2
Department of Ultrasound, Sun Yat‑Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
3
Department of MRI, Maoming People Hospital, No. 101 Weimin Road, Maoming 525000, Guangdong, China
Cervical cancer is the fourth most common cancer for women worldwide and the leading cause of cancer death for women in developing countries [1]. Pelvic lymph node metastasis (PLNM) has an important influence
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