ACR Appropriateness Criteria®
Clinical Condition: Endometrial Cancer of the Uterus
Variant 1: Newly diagnosed endometrial cancer - diagnostic work-up.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
MRI, pelvis |
8 |
|
MRI, abdomen |
4 |
|
X-ray, chest |
6 |
|
CT, abdomen |
4 |
|
CT, pelvis |
4 |
|
US, uterus |
4 |
|
X-ray, kidney, intravenous urography, IVP |
2 |
|
X-ray, colon, barium enema |
2 |
|
INV, pelvis, lymphangiography |
2 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 2: Assessing the depth of myometrial invasion.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
MRI, uterus, with contrast |
9 |
|
MRI, uterus, without contrast |
6 |
|
CT, pelvis |
6 |
|
US, uterus, endovaginal |
6 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 3: Overall staging.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
MRI, pelvis, with contrast |
8 |
Contrast significantly improves evaluation. |
MRI, pelvis, without contrast |
6 |
|
CT, pelvis |
4 |
|
US, uterus, endovaginal |
4 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 4: Lymph node evaluation.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
CT, pelvis |
8 |
Either CT or MRI is appropriate. |
MRI, pelvis |
8 |
Either CT or MRI is appropriate. |
US, pelvis |
2 |
|
Lymphangiography, pelvis |
2 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 5: Assessing endocervical tumor extent.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
MRI, pelvis |
8 |
|
CT, pelvis |
4 |
|
US, uterus, endovaginal |
4 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
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