Role of imaging in the routine management of endometrial cancer

Abstract

Endometrial cancer is the most common gynecologic cancer in women today. It is surgically staged, and while surgery is the primary treatment modality, the identification of disease extent—in particular extrauterine spread—prior to surgery is important to optimize treatment decision making. Ultrasound and MRI are useful for evaluating the extent of local disease, while CT and PET are used for detecting lymph node or distant metastases. Diffusion-weighted MRI has also been used for detecting small metastatic deposits in lymph nodes and omentum. Extrauterine soft tissue involvement can be detected by ultrasound, CT, MRI, and PET. Recently, intraoperative visualization techniques, such as sentinel lymph node mapping, are increasingly used to avoid extensive surgical staging without compromising treatment. Imaging is also used for planning adjuvant treatment and detection of postoperative residual disease in high-risk patients, monitoring and detecting recurrent disease, and in post-treatment surveillance of asymptomatic patients with high risk of relapse.

A Novel Approach to Preoperative Risk Stratification in Endometrial Cancer: The Added Value of Immunohistochemical Markers

“…All patients underwent a clinical examination, preoperative ultrasound staging examination, and CT of the chest/abdomen according to the local guidelines (11, 12). Each patient underwent both a transabdominal and a transvaginal US scan within 14 days before a board discussion led by one of the two oncogynecologists experienced in the field of US diagnostics in gynecologic oncology.…”

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

“…The cost of MRI and the results of the latest meta‐analyses indicate that transvaginal US may play a role in evaluating MI in women with EC, especially in low‐risk cases . Total abdominal hysterectomy (TAH) and bilateral salpingo‐oophorectomy (BSO) are usually indicated for curative treatment of EC with highly or moderately differentiated histology and invasion limited to the inner half of the myometrium evidenced by US (FIGO stage 1A) even without MRI …”

“…Although less useful in assessing uterine abnormalities than MRI and US, CT scan has better multiplanar spatial resolution and is useful for visualizing large lymph nodes and pulmonary metastases in the entire abdominopelvic cavity …”

“…10 Total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) are usually indicated for curative treatment of EC with highly or moderately differentiated histology and invasion limited to the inner half of the myometrium evidenced by US (FIGO stage 1A) even without MRI. 11 In areas with limited availability of imaging examination, TAH with adnexectomy is acceptable, and in the absence of SLNM, macroscopic examination of the myometrium of the hysterectomy specimen may guide lymph node staging because this method correctly identifies the extent of MI in 89% of patients. 12 Although less useful in assessing uterine abnormalities than MRI and US, CT scan has better multiplanar spatial resolution and is useful for visualizing large lymph nodes and pulmonary metastases in the entire abdominopelvic cavity.…”

Near-Infrared Fluorescent Imaging for Monitoring of Treatment Response in Endometrial Carcinoma Patient-Derived Xenograft Models

“…In the present study, we find that EpCAM-AF680 NIRF enables identification of metastases. This is a major strength, as correct evaluation of disseminated disease is important for both preclinical purposes as well as clinical management of disease [37]. Further, with NIRF imaging there is no need for radioactive tracers.…”