The Role of the Diffusion Coefficient as a Biomarker in Cervical Cancer Diagnosis and in Assessing the Therapeutic Response to Neoadjuvant Treatment

Abstract

 Introduction: The apparent diffusion coefficient (ADC) is a significant parameter in the diagnosis and monitoring of cervical cancer.

 Aim: Evaluation of ADC values in patients with cervical cancer, post-therapeutic changes, and normal findings, analyzing their association with clinicopathological parameters, predicting therapeutic outcomes, and differentiating residual tumors from post-therapeutic tissue without residual tumors.

 Materials and Methods: A retrospective study included 148 patients divided into three groups: cervical cancer, post-therapeutic changes, and normal findings. ADC values were measured by positioning the ROI in the target tissue. Statistical analyses included ANOVA, t-tests, and ROC analysis.

 Results: The mean ADC values for cervical cancer (0.798 × 10³ mm²/s) were significantly lower compared to post-therapeutic changes (1.394 × 10⁻³ mm²/s) and normal findings (1.431 × 10⁻³ mm²/s; p < 0.001). ADC values did not show statistically significant differences based on clinicopathological parameters. The change in ADC values after therapy (∆ADC: 0.607 × 10⁻³ mm²/s) indicated reduced cellularity. The mean ADC values of residual tumors (1.299 × 10⁻³ mm²/s) were significantly lower compared to post-therapeutic tissue without residual tumors (1.472 × 10⁻³ mm²/s; p = 0.029). The optimal value for distinguishing residual tumors from post-therapeutic tissue without residual tumors was 1.436 × 10⁻³ mm²/s. The optimal value for differentiating pre- and post-therapeutic tumor tissue was 0.929 × 10⁻³ mm²/s.

 Conclusion: ADC is a reliable biomarker for differentiating cervical cancer, post-therapeutic changes, normal findings, and for assessing therapeutic response. ADC provides significant differentiation between residual tumors and post-therapeutic tissue without residual tumors.