MRI differentiation of usual type endocervical adenocarcinoma and cervical squamous cell carcinoma

Abstract

Objectives To evaluate the magnetic resonance imaging (MRI) features that may help differentiate usual-type endocervical adenocarcinoma (UEA) from cervical squamous cell carcinoma (SCC), with particular emphasis on diffusion-weighted imaging–derived apparent diffusion coefficient (ADC) values and tumor growth patterns. Methods This retrospective study included 26 patients with histopathologically confirmed UEA and 50 patients with SCC who underwent preoperative pelvic MRI. Quantitative MRI parameters—including tumor size, tumor-to-muscle signal intensity ratios (SIRs) on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE-T1WI), and mean ADC values—were analyzed. Qualitative imaging features such as tumor growth pattern, location, uterine corpus invasion, intratumoral cyst formation, hydrometra/hematometra, and lymphadenopathy were also assessed. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of ADC values. Multivariable logistic regression analysis was used to identify independent predictors of UEA. Interobserver agreement was assessed using intraclass correlation coefficients (ICC) and Cohen’s kappa statistics. Results Mean ADC values were significantly higher in the UEA group than in the SCC group (0.901 × 10 ⁻ ³ mm²/s vs. 0.825 × 10 ⁻ ³ mm²/s, p = 0.008). ROC analysis showed a statistically significant but moderate discriminatory performance of mean ADC for differentiating UEA from SCC (AUC = 0.659; 95% CI: 0.527–0.790; p = 0.024). Using the Youden index, an optimal ADC cut-off value of 0.837 × 10 ⁻ ³ mm²/s yielded a sensitivity of 65.4% and a specificity of 62.0% for identifying UEA. Endophytic growth was more frequently observed in UEA, whereas mixed growth was more common in SCC (p = 0.023). Intratumoral cyst formation was observed exclusively in UEA (p = 0.004). In multivariable analysis, mean ADC value and tumor growth pattern were independent predictors of UEA. Interobserver agreement for quantitative and qualitative MRI assessments was excellent. Conclusion Higher ADC values, an endophytic growth pattern, and the presence of intratumoral cysts are useful MRI features for differentiating usual-type endocervical adenocarcinoma from cervical squamous cell carcinoma. These imaging characteristics may contribute to improved preoperative diagnostic accuracy and treatment planning.