title: Simultaneous changes of magnetic resonance diffusion-weighted imaging and pathological microstructure in locally advanced cervical cancer caused by neoadjuvant chemotherapy.
abstract: OBJECTIVE
  To investigate the changes to diffusion-weighted imaging (DWI) correlated with histopathology after neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC).
  
  
  METHODS
  Thirty-three patients with LACC were examined with 3T magnetic resonance imaging (MRI) with DWI and apparent diffusion coefficient (ADC) maps. MRIs were performed for each patient at three timepoints: before the first NACT, 2 weeks after the first NACT, and 2 weeks after the second NACT. Uterine cervical specimens were collected at the same timepoints. Specimens were stained for tumor cell density, proliferating cell nuclear antigen (PCNA), and aquaporin 1 (AQP1). Treatment responses were classified as the effective group (complete and partial response) and the ineffective group (stable and progressive disease).
  
  
  RESULTS
  The ADC value of the effective group after the first chemotherapy was higher than that before chemotherapy (P = 0.002), and expressions of three pathological indicators (tumor cell density, PCNA, and AQP1) significantly decreased after the first NACT compared with those prechemotherapy (P < 0.001). Changes of PCNA expression were negatively correlated with changes of ADC values after the first NACT in the effective group (r = -0.56, P = 0.03). Changes of cellular density were negatively correlated with changes of ADC values from the time of prechemotherapy to after the second NACT in the effective group (r = -0.51, P = 0.04).
  
  
  CONCLUSIONS
  The ADC change after successful chemotherapy is closely related with cellular characteristics preceding size reduction. ADC may be used as an early imaging biomarker of NACT response in LACC.
authors.affiliation: Department of Gynecology and Obstetrics, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
authors.forename: Chun
authors.initials: C
authors.lastname: Fu
authors.affiliation: Department of Gynecology and Obstetrics, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Feng
authors.affiliation: Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
authors.forename: Dujun
authors.initials: D
authors.lastname: Bian
authors.affiliation: Department of Gynecology and Obstetrics, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Gynecology and Obstetrics, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
authors.forename: Wanping
authors.initials: W
authors.lastname: Du
authors.affiliation: Department of Research, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
authors.forename: Lan
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Gynecology and Obstetrics, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
authors.forename: Xiangquan
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents
keywords: locally advanced cervical cancer; magnetic resonance diffusion-weighted imaging; neoadjuvant chemotherapy; pathological microstructure