OBJECTIVE To investigate the value of apparent diffusion coefficient (ADC) histogram analysis in predicting pelvic lymph node (LN) metastasis in patients with cervical cancer undergoing surgery. MATERIALS AND METHODS A total of 162 cervical cancer patients who underwent radical abdominal hysterectomy with pelvic LN dissection performed with pelvic 3 T-MRI including diffusion-weighted imaging were enrolled in this study. The ADC histogram variables (minimum, mean, median, 97.5th percentile [ADC97.5], and maximum) of the tumors were developed using in-house software. For predicting pelvic LN metastasis, clinical and imaging variables were evaluated using logistic regression and receiver-operating characteristic (ROC) analyses. RESULTS Pelvic LN metastasis was identified histopathologically in 50 patients (30.9%). In patients with LN metastasis, all ADC histogram variables were significantly different from those without LN metastasis (all p < 0.01). Univariate analysis demonstrated that long- and short-axis diameter of LN, MRI T-stage, squamous cell carcinoma antigen, tumor size, and the ADC97.5 were significantly associated with pelvic LN metastasis (all p < 0.05). However, multivariate analysis demonstrated that the ADC97.5 was the only independent predictor of pelvic LN metastasis (odds ratio, 0.996; p = 0.001). The area under the ROC curve of ADC97.5 was 0.782, which was the greatest among all variables. Interobserver agreement of all ADC histogram variables was fair to good. DISCUSSION The ADC97.5 from histogram analysis may be a useful marker for the prediction of pelvic LN metastasis in patients with cervical cancer.

中文翻译：

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视扩散系数的直方图分析，可预测子宫宫颈癌患者的盆腔淋巴结转移情况。

目的探讨表观扩散系数（ADC）直方图分析在预测宫颈癌手术患者盆腔淋巴结（LN）转移中的价值。材料与方法本研究共入组162例宫颈癌患者，他们接受了包括弥散加权成像在内的盆腔3 T-MRI进行的盆腔LN根治性根治性腹腔全子宫切除术。使用内部软件开发了肿瘤的ADC直方图变量（最小值，平均值，中位数，第97.5个百分位数[ADC97.5]和最大值）。为了预测骨盆LN转移，使用逻辑回归和接受者操作特征（ROC）分析评估了临床和影像学变量。结果在50例患者中（30.9％）在组织病理学上确定了盆腔LN转移。在LN转移患者中，所有ADC直方图变量均与无LN转移的变量显着不同（所有p <0.01）。单因素分析表明，LN的长轴和短轴直径，MRI T期，鳞状细胞癌抗原，肿瘤大小和ADC97.5与骨盆LN转移显着相关（所有p <0.05）。但是，多变量分析表明，ADC97.5是盆腔LN转移的唯一独立预测因子（比值比为0.996； p = 0.001）。ADC97.5的ROC曲线下面积为0.782，在所有变量中最大。所有ADC直方图变量的观察者之间的一致性都很好。讨论直方图分析的ADC97.5可能是预测宫颈癌患者盆腔LN转移的有用标志物。