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

Jelena Vasić¹Nataša Prvulović Bunović^1,2Milica Šarošković¹Jelena Vuković³Stefan Stojanoski^1,2Igor Nosek^1,2Miloš Vuković^1,2*

• ¹Faculty of Medicine, University of Novi Sad, Novi Sad, Vojvodina, Serbia
• ²Diagnostic Imaging Centre, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
• ³Department of Gynaecology and Obstetrics, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia Obstetrics and Gynaecology Clinic, Clinical Center of Vojvodina, Novi Sad, Serbia

The apparent diffusion coefficient (ADC) is a significant parameter in the diagnosis and monitoring of cervical cancer. The aim of this study is to evaluate ADC values in patients with cervical cancer, post-therapeutic changes, and normal findings, in order to assess their association with clinicopathological parameters, predict therapeutic outcomes, and differentiate residual tumors from post-treatment tissue without residual disease. Methods: A retrospective study included 148 patients divided into three groups: cervical cancer, posttherapeutic changes and normal findings. ADC values were measured by positioning ROI in the target tissue. Statistical analyses included ANOVA, t-tests, and ROC analysis.The mean ADC values for cervical cancer (0.798 × 10⁻³ 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. Discussion: ADC proved to be a reliable imaging biomarker for differentiating cervical cancer, posttherapeutic changes, and normal findings, as well as for assessing therapeutic response. It demonstrated significant potential in distinguishing residual tumor tissue from post-treatment changes without residual disease.