Whole-tumor ADC histogram analysis for differentiating endometriosis-related tumors: seromucinous borderline tumor, clear cell carcinoma and endometrioid carcinoma

Abstract Background: In view of the similar MRI findings of endometriosis-related ovarian neoplasms, this study aimed to investigate the feasibility of whole-tumor apparent diffusion coefficient (ADC) histogram analysis for differentiating endometriosis-related tumors: seromucinous borderline tumor (SMBT), clear cell carcinoma (CCC) and endometrioid carcinoma (EC). Methods: A total of 85 patients (22 with SMBT, 42 with CCC and 21 with EC) were retrospectively enrolled. Clinical data including age, stage, laterality, solid component ADC (ADC SC ) and whole-tumor ADC histogram-derived parameters, such as the volume, ADC mean , the 10th, 50th and 90th percentile ADCs, inhomogeneity, skewness, kurtosis and entropy, were compared among SMBT, CCC and EC. The diagnostic efficacy of these parameters was evaluated using receiver operating characteristic curve analysis. Results: There were significant differences in age, ADC SC and histogram parameters including volume, ADC mean , the 10th, 50th and 90th percentile ADCs among three kinds of tumors (all p < 0.05). Patients with SMBT were significantly younger than patients with CCC/EC. The significantly higher ADC SC and smaller volume were found in SMBT than in CCC/ EC. The ADC mean was significantly higher in CCC than in EC. The 10th percentile ADC was significantly lower in EC than in SMBT/CCC. The 50th and 90th percentile ADCs were significantly higher in CCC than in SMBT/EC. For differentiating SMBT from CCC, AUCs of the ADC SC , volume, the 50th and 90th percentile ADCs were 0.97, 0.86, 0.72 and 0.81, respectively. For differentiating SMBT from EC, AUCs of the ADC SC , volume and the 10th percentile ADC were 0.97, 0.71 and 0.72, respectively. For differentiating CCC from EC, AUCs of the ADC mean , the 10th, 50th and 90th percentile ADCs were 0.79, 0.72, 0.81 and 0.85, respectively. Conclusions: Similar with ADC SC , whole-tumor ADC histogram analysis was valuable for differentiating endometriosis-related tumors. It was helpful for the 50th, 90th percentile ADCs and volume in differentiating SMBT from CCC; for the volume and 10th percentile ADC in differentiating SMBT from EC, and for the ADC mean , the 10th, 50th and 90th percentile ADCs in differentiating CCC from EC.