Diagnostic utility of apparent diffusion coefficient values in cervical cancer staging: A retrospective study

Background and purpose: Accurate staging is critical for therapeutic planning, which directly determines prognosis, as management shifts from surgical resection in early stages to concurrent chemoradiation in advanced disease. We aimed to evaluate diagnostic utility of apparent diffusion coefficient (ADC) in staging of cervical cancer. Material and methods: A retrospective study of 146 consecutive patients with histopathologically confirmed cervical cancer, who underwent pelvic MRI with DWI at our tertiary care center was conducted. Two independent radiologists performed tumor staging according to FIGO staging classification and regions of interest were drawn on ADC maps. Spearman's rank correlation was employed to evaluate the relationship between ADC values and age, stage, and tumor size. Diagnostic performance parameters, including sensitivity, specificity, and area under the curve (AUC) were assessed. Results: Median ADC values (×10⁻⁶ mm²/s) decreased significantly with disease progression: stage I, 966 (IQR: 182); stage II, 830 (IQR: 287); stage III, 811 (IQR: 230); and stage IV, 750 (IQR: 231); p < 0.05. Moreover, median ADC values differed significantly between patients with and without parametrial, vaginal, and lymph node involvement. (p-values <0.05). ADC values distinguished tumors of ≥ 4 cm from smaller ones with a sensitivity and specificity of 82.1% and 47.8%, respectively. Parametrial and lymph node involvement were detected using ADC values with sensitivities of 85.0% and 68.8% and specificities of 58.0% and 57.1%, respectively. Conclusion: ADC values could be a reliable tool for facilitating more accurate cervical cancer staging and could inform clinical management and decision-making on therapy intensification or de-escalation.