Development of an apparent diffusion coefficient based on nomogram for the preoperative prediction of Ki-67 and p53 expression levels and myometrial infiltration in endometrial cancer

Background: Endometrial cancer (EC) has been increasing in incidence and mortality rates over the years. To investigate the feasibility of ADC in preoperative non-invasive prediction of myometrial infiltration and Ki-67 and p53 expression levels in patients with EC. Methods we performed the retrospective analysis of 105 patients with EC who underwent preoperative magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) and were confirmed by pathology after operation from January 2017 to December 2021 in our hospital. Two independent radiologists measured the ADC values (ADC max , ADC mean , and ADC min ) of EC on the ADC image by comparing the MRI enhancement and DWI images, respectively. Statistical methods were used to calculate the correlation between clinical information, ADC values and myometrial infiltration and Ki-67 and p53 expression in EC patients. A nomogram prediction model was constructed and evaluated via receiver operating characteristic (ROC) curve and calibration curve analysis. Results The ADC values were significantly correlated with the myometrial infiltration and Ki-67 and p53 expression levels in EC patients (all P  < 0.05). The International Federation of Gynecology and Obstetrics (FIGO) stage only significantly associated with the myometrial infiltration and Ki-67 expression levels in EC patients (all P  < 0.05). The ADC max , ADC mean , and ADC min were combined with the FIGO stage to construct the nomogram model. The nomogram model, ADC max , ADC mean , ADC min , and FIGO stage predicted AUC values of 0.809, 0.707, 0.693, 0.694, and 0.599 for myometrial infiltration, respectively; the AUC values for predicting Ki-67 expression levels were 0.897, 0.879, 0.849, 0.808 and 0.550, respectively. The nomogram model was constructed by combining the ADC max , ADC mean , ADC min . The AUC values predicted by the nomogram, ADC max , ADC mean , ADC min were 0.665, 0.615, 0.641 and 0.654, respectively. Conclusions The nomogram model based on ADC values combined with the FIGO stage could be a useful method for the preoperative non-invasive assessment of myometrial infiltration and Ki-67 and p53 expression in EC patients.