MR volumetry in predicting the aggressiveness of endometrioid adenocarcinoma: correlation with final pathological results

Background Magnetic resonance (MR) has been widely used in predicting the aggressiveness of endometrioid adenocarcinoma. However, the diagnostic value of the MR volume of the lesion has been controversial. Purpose To determine whether the whole-lesion MR volume measurement could be used as a better predictor for evaluating the aggressiveness of endometrioid adenocarcinoma. Material and Methods In this retrospective study, we include 357 patients with pathologically demonstrated endometrioid adenocarcinoma at our institution between 1 January 2013 and 31 December 2018. Whole-lesion MR volume was calculated on sagittal T2-weighted images with ITK-SNAP software on a personal computer. Results According to the receiver operating characteristics curve analysis, whole-lesion MR volume has the competitive advantage in evaluating deep myometrial invasion compared with the frozen results, generating area under the curve (AUC) values of 0.751 vs. 0.834 (P = 0.0629, Z = 1.860). The AUC of tumor maximum diameter, simple tumor volume, and whole-lesion MR volume in predicting deep myometrial invasion was 63.8%, 67.6%, and 75.1%, respectively. Conclusion Whole-lesion MR volume is a good diagnostic tool for prediction of deep myometrial invasion, lymph node metastasis, and lymphovascular invasion. MR volumetry could reflect the aggressiveness of endometrioid adenocarcinoma more accurately than traditional lesion measurements.