FIGO Staging System for Endometrial Cancer: Added Benefits of MR Imaging

Abstract

Endometrial cancer is the most commonly diagnosed gynecologic malignancy in the United States. This pathologic condition is staged with the International Federation of Gynecology and Obstetrics (FIGO) system. The FIGO staging system recently underwent significant revision, which has important implications for radiologists. Key changes incorporated into the 2009 FIGO staging system include simplification of stage I disease and removal of cervical mucosal invasion as a distinct stage. Magnetic resonance (MR) imaging is essential for the preoperative staging of endometrial cancer because it can accurately depict the depth of myometrial invasion, which is the most important morphologic prognostic factor and correlates with tumor grade, presence of lymph node metastases, and overall patient survival. Diffusion-weighted MR imaging and dynamic contrast medium-enhanced MR imaging are useful adjuncts to standard morphologic imaging and may improve overall staging accuracy.

Added Value of Perfusion in Gynaecological Imaging

“…Endometrial cancer is staged using the International Federation of Gynecology and Obstetrics (FIGO) system [23]. Since the condition is predominantly treated surgically, staging according to the revised FIGO classification is mainly surgical [24].…”

Diffusion-weighted and diffusion-tensor imaging of normal and diseased uterus

“…Histologic grade, stage, level of myometrium invasion, existence of nodal metastases, invasion of lymphoid and vascular structures all effect the prognosis of endometrial cancer. However the most important factor effecting prognosis is the depth of myometrium invasion [30] . The success of DWI has been improved in the assessment of accurate myometrium inavasion detection and in differentiating tumor recurrence from posttheraupetic findings [31] .…”

“…Tumors infiltrating the exterior half of the myometrial zone are defined as stage ⅠB tumors. These revisions include simplification of stage Ⅰ disease and determination of cervical infiltration as a distinct stage to increase the diagnostic value of MRI [30] . [29] , the ADC value was 84.6% successful in detecting endometrial cancer.…”

“…It may also give additional information for preoperative assessment and should be performed as a part of routine MRI for endometrial tumors. Besides, DWI is a useful technique increasing the accuracy of staging [30] .…”

Synchronous gynecologic cancer and the use of imaging for diagnosis

“…4 When endometrial cancer is clinically suspected, diagnosis is made based on histological and imaging evaluation of the endometrium, while cervical cancers are diagnosed clinically, according to the International Federation of Gynecology and Obstetrics (FIGO). 5 The authors report a case of synchronous tumors of endometrial and cervical cancers in an oncological reference center that was suspected clinically and evidenced on magnetic resonance imaging (MRI) of the pelvis, discussing the relevant finding for diagnosis.…”