Korelasi Nilai ADC MRI dengan Grading Histopatologi dan Staging Figo pada Karsinoma Endometrium

Galuh Kartika Dewi, Prof. DR. dr. Lina Choridah, Sp.Rad (K)-PRP.; dr. Hesti Gunarti, Sp.Rad(K)-RA

2025 | Tesis-Spesialis | S2 Radiologi

Latar Belakang: Karsinoma endometrium merupakan kanker ginekologi tersering di negara maju dan menduduki peringkat ke-12 di Indonesia. Penentuan staging FIGO dan grading histopatologi ini penting untuk menentukan tatalaksana serta memprediksi prognosis. MRI pelvis dengan sekuens DWI/ADC memiliki potensi menjadi biomarker non-invasif untuk menilai agresivitas tumor.

Tujuan: Menilai korelasi ADC mean dan ADC ratio pada MRI pelvis dengan grading histopatologi dan staging FIGO pada karsinoma endometrium.

Metode: Studi analisis retrospektif cross-sectional terhadap 40 pasien karsinoma endometrium yang menjalani pemeriksaan MRI pelvis pada Januari 2017–Juli 2025. Dilakukan pengukuran ADC mean tumor serta ADC ratio terhadap myometrium (ADC ratiot-m) dan otot gluteus maximus (ADC ratiot-g), kemudian dianalisis korelasinya dengan staging dan grading. 

Hasil: Pasien mayoritas berusia 50–69 tahun dengan tipe histopatologi endometrioid (90%), staging IB (37,5%), dan grade 3 (47,5%). Nilai ADC mean tidak menunjukkan hubungan yang signifikan dengan staging maupun grading (p>0,05), dengan nilai rata-rata ADC mean pada G1: 0,74 ± 0,14, G2: 0,67± 0,10, dan G3: 0,68± 0,09 ×10?³ mm²/s. Nilai ADC ratiot-g, yang berkisar antara 0.44–0.70, menunjukkan korelasi negatif dengan kekuatan sedang terhadap staging (r = –0,424; p = 0,006). Sementara itu, ADC ratiot-m (G1: 0,57; G2: 0,50; G3: 0,47) dan ADC ratiot-g (G1: 0,69; G2: 0,55; G3: 0,54) menunjukkan korelasi negatif dengan kekuatan lemah terhadap grading histopatologi (r = –0,385; p = 0,014 dan r = –0,334; p = 0,035)

Kesimpulan: Nilai ADC mean tidak dapat membedakan staging FIGO dan grading Histopatologi. Sedangkan ADC ratio, khususnya ADC ratiot-g, lebih konsisten dan berpotensi sebagai parameter kuantitatif non-invasif dalam menilai agresivitas karsinoma endometrium.

Background: Endometrial carcinoma is the most common gynecological malignancy in developed countries and ranks 12th among cancers in Indonesia. Determination of FIGO staging and histopathological grading is essential for guiding management and predicting prognosis. Pelvic MRI with DWI/ADC sequences has the potential to serve as a non-invasive biomarker for assessing tumor aggressiveness.

Objective: to evaluate the correlation between mean ADC value and ADC ratio on pelvic MRI with histopathological grading and FIGO staging in endometrial carcinoma.

Methods: A retrospective cross-sectional study was conducted on 40 patients with endometrial carcinoma who underwent pelvic MRI between January 2017 and July 2025. Tumor mean ADC values and ADC ratios relative to the myometrium (ADC ratiot-m) and gluteus maximus muscle (ADC ratiot-g) were measured and analyzed for correlations with staging and grading. Results: Most patients were aged 50–69 years, with endometrioid histopathological type (90%), FIGO stage IB (37.5%), and grade 3 (47.5%). The mean ADC value showed no significant correlation with either staging or grading (p>0.05), with mean ADC values of G1: 0.74 ± 0.14, G2: 0.67 ± 0.10, and G3: 0.68 ± 0.09 ×10?³ mm²/s. The ADC ratiot-g, ranging from 0.44 to 0.70, demonstrated a moderate negative correlation with staging (r = –0.424; p = 0.006). Meanwhile, ADC ratiot-m (G1: 0.57; G2: 0.50; G3: 0.47) and ADC ratiot-g (G1: 0.69; G2: 0.55; G3: 0.54) showed weak negative correlations with histopathological grading (r = –0.385; p = 0.014 and r = –0.334; p = 0.035, respectively).

Conclusion: Absolute mean ADC values cannot reliably differentiate staging or grading. ADC ratios, particularly ADC ratiot-g, demonstrated more consistent correlations and may serve as quantitative non-invasive parameters for assessing tumor aggressiveness in endometrial carcinoma.

Kata Kunci : Karsinoma endometrium, MRI, ADC, grading histopatologi, staging FIGO