• Hricak H, Akin O, Sala E, Fleischer AC, Bohm-Velez M, Fishman EK, Mendelson E, Thurmond A, Goldstein S, Expert Panel on Women's Imaging. Endometrial cancer of the uterus. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 6 p. [32 references]

This is the current release of the guideline.

This guideline updates a previous version: Hricak H, Mendelson E, Böhm-Vélez M, Bree RL, Finberg H, Fishman EK, Laing F, Sartoris D, Thurmond A, Goldstein S. Endometrial cancer of the uterus. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun 1;215(Suppl):947-53.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

Endometrial cancer of the uterus

Evaluation

Obstetrics and Gynecology
Oncology
Radiology

Health Plans
Hospitals
Managed Care Organizations
Physicians
Utilization Management

To evaluate the appropriateness of radiologic examinations for the evaluation of endometrial cancer of the uterus

Women with endometrial cancer of the uterus

1. Magnetic resonance imaging
   • Pelvis, with and without contrast
   • Abdomen
   • Uterus, with and without contrast
2. X-ray
   • Chest
   • Kidney, intravenous urography, intravenous pyelogram
   • Colon, barium enema
3. Computed tomography
   • Pelvis
   • Abdomen
4. Ultrasound, uterus
   • Endovaginal
5. Invasive, pelvis, lymphangiography

Utility of radiologic examinations in evaluation and staging

Searches of Electronic Databases

The guideline developer performed literature searches of recent peer-reviewed medical journals, and the major applicable articles were identified and collected.

The total number of source documents identified as the result of the literature search is not known.

Weighting According to a Rating Scheme (Scheme Not Given)

Not stated

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

One or two topic leaders within a panel assume the responsibility of developing an evidence table for each clinical condition, based on analysis of the current literature. These tables serve as a basis for developing a narrative specific to each clinical condition.

Expert Consensus (Delphi)

Since data available from existing scientific studies are usually insufficient for meta-analysis, broad-based consensus techniques are needed for reaching agreement in the formulation of the appropriateness criteria. The American College of Radiology (ACR) Appropriateness Criteria panels use a modified Delphi technique to arrive at consensus. Serial surveys are conducted by distributing questionnaires to consolidate expert opinions within each panel. These questionnaires are distributed to the participants along with the evidence table and narrative as developed by the topic leader(s). Questionnaires are completed by participants in their own professional setting without influence of the other members. Voting is conducted using a scoring system from 1-9, indicating the least to the most appropriate imaging examination or therapeutic procedure. The survey results are collected, tabulated in anonymous fashion, and redistributed after each round. A maximum of three rounds is conducted and opinions are unified to the highest degree possible. Eighty percent agreement is considered a consensus. This modified Delphi technique enables individual, unbiased expression, is economical, easy to understand, and relatively simple to conduct.

If consensus cannot be reached by the Delphi technique, the panel is convened and group consensus techniques are utilized. The strengths and weaknesses of each test or procedure are discussed and consensus reached whenever possible. If "No consensus" appears in the rating column, reasons for this decision are added to the comment sections.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

Criteria developed by the Expert Panels are reviewed by the American College of Radiology (ACR) Committee on Appropriateness.

ACR Appropriateness Criteria®

Clinical Condition: Endometrial Cancer of the Uterus

Variant 1: Newly diagnosed endometrial cancer - diagnostic work-up.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 2: Assessing the depth of myometrial invasion.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 3: Overall staging.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 4: Lymph node evaluation.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Variant 5: Assessing endocervical tumor extent.

Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.

Recommended Imaging Approach

Ultrasound, especially with the use of endovaginal sonography, is sometimes considered to be the primary imaging approach. However, in patients in whom ultrasound is suboptimal or in whom the results of imaging studies will directly influence the choice of therapy and guide in therapy planning, the higher accuracy of contrast-enhanced MR imaging warrants its use. In patients presenting with a large endometrial tumor, MRI should be preferred to CT and should be the primary imaging technique. If cervical involvement is the major clinical concern, MRI is the study of choice. However, there are no outcome studies or cost-effectiveness analyses on imaging evaluation of endometrial cancer. Positron emission tomography is promising in the post-treatment surveillance of endometrial cancer patients. The views expressed in this summary are a combination of literature review and expert opinion.

Conclusion

Patients with endometrial carcinoma should undergo cross-sectional imaging only in cases of clinical staging difficulties, including obese patients, patients with large tumors, poor histologic tumor grade, or possible cervical involvement. If imaging is needed, MRI is the most accurate technique and should be the primary imaging modality.

Abbreviations

• CT, computed tomography
• INV, invasive
• IVP, intravenous pyelogram
• MRI, magnetic resonance imaging
• US, ultrasound

Algorithms were not developed from criteria guidelines.

The recommendations are based on analysis of the current literature and expert panel consensus.

Selection of appropriate radiologic imaging procedures for the evaluation of endometrial cancer of the uterus

Not stated

An American College of Radiology (ACR) Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those exams generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the U.S. Food and Drug Administration (FDA) have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.

An implementation strategy was not provided.

Living with Illness

Effectiveness

• Hricak H, Akin O, Sala E, Fleischer AC, Bohm-Velez M, Fishman EK, Mendelson E, Thurmond A, Goldstein S, Expert Panel on Women's Imaging. Endometrial cancer of the uterus. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 6 p. [32 references]

Not applicable: The guideline was not adapted from another source.

2000 (revised 2005)

American College of Radiology - Medical Specialty Society

The American College of Radiology (ACR) provided the funding and the resources for these ACR Appropriateness Criteria®.

Committee on Appropriateness Criteria, Expert Panel on Women's Imaging

Panel Members: Hedvig Hricak, MD, PhD (Principal Author); Oguz Akin, MD (Research Author); Evis Sala, MD, PhD (Research Author); Arthur C. Fleischer, MD (Panel Chair); Marcela Böhm-Vélez, MD; Elliot K. Fishman, MD; Ellen Mendelson, MD; Amy Thurmond, MD; Steven Goldstein, MD

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Hricak H, Mendelson E, Böhm-Vélez M, Bree RL, Finberg H, Fishman EK, Laing F, Sartoris D, Thurmond A, Goldstein S. Endometrial cancer of the uterus. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000 Jun 1;215(Suppl):947-53.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

None available

This NGC summary was completed by ECRI on February 10, 2006.