Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology
To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI.
The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as “RECOMMENDED” versus “NOT RECOMMENDED” (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts).
Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended.
These consensus recommendations should be used as a guide for endometrial cancer staging with MRI.
• MRI is recommended for initial staging of endometrial cancer.
• MR imaging protocol should be tailored based on the risk of lymph node metastases.
• Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging.
• The mnemonic “Clinical and MRI Critical TEAM” summarizes key elements of the standardized report.
KeywordsMagnetic resonance imaging Endometrial cancer Guideline Diffusion Uterus
Cervical stromal invasion
Dynamic contrast-enhanced MRI
European Society for Medical Oncology
European Society of Urogenital Radiology
Field of view (FOV) optimized and constrained undistorted single-shot DWI
Magnetic resonance imaging
RAND-UCLA Appropriateness Method
Sentinel lymph node
The committee would like to thank Mr Arnold Stipsits, ESUR secretary, for his help with co-ordination of the committee members. The authors would like to acknowledge the contribution of information specialist Dr. Martina Gosteli (Main library - Medicine Careum, University of Zurich) for her valuable assistance with the database searches. We would like to thank the following colleagues: Henrik Leonhardt, Celine Alt, Federico Collettini, Laure Fournier, Diomidis Botsikas, Gavin Stewart, Athina C. Tsili, Theresa Mokry, Riccardo Manfredi, Laura Bunesch Villalba, Sonya Snape, Hebert Alberto Vargas, Maryna Brochwicz-Lewinski, M. Weston, Suzan M. Goldman and Sara Belião for participating to the questionnaire on behalf of the ESUR women’s imaging group. Authors thank Joanne Chin M.F.A. for her editorial assistance with the manuscript.
Yulia Lakhman's contribution to this work was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
Compliance with ethical standards
The scientific guarantor of this publication is Rosemarie Forstner
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was not required for this study because no patient data were used.
Institutional review board approval was not required because no patient data were used.
• multicentre study
- 2.Colombo N, Preti E, Landoni F et al (2013) Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24 Suppl 6:vi33-8Google Scholar
- 3.Colombo N, Creutzberg C, Amant F et al (2016) ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer 26:2–30Google Scholar
- 4.Colombo N, Creutzberg C, Amant F et al (2016) ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol 27:16–41Google Scholar
- 5.Rossi EC, Kowalski LD, Scalici J et al (2017) A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol 18:384–392Google Scholar
- 6.Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging-a meta-analysis and Bayesian analysis. Radiology 216:444–449Google Scholar
- 7.Cunha TM, Felix A, Cabral I (2001) Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: comparison of magnetic resonance imaging and gross visual inspection. Int J Gynecol Cancer 11:130–136Google Scholar
- 8.Bhosale P, Ma J, Iyer R et al (2016) Feasibility of a reduced field-of-view diffusion-weighted (rFOV) sequence in assessment of myometrial invasion in patients with clinical FIGO stage I endometrial cancer. J Magn Reson Imaging 43:316–324Google Scholar
- 14.Beets-Tan RG, Lambregts DM, Maas M et al (2013) Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 23:2522–2531PubMedPubMedCentralGoogle Scholar
- 15.Beets-Tan RGH, Lambregts DMJ, Maas M et al (2018) Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 28:1465–1475PubMedPubMedCentralGoogle Scholar
- 19.Emlik D, Kiresi D, Özdemir S, Çelik C, Karaköse S (2010) Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma: comparison of multi-section dynamic MR imaging using a three dimensional FLASH technique and T2-weighted MR imaging. J Med Imaging Radiat Oncol 54:202–210PubMedPubMedCentralGoogle Scholar
- 39.Horta M, Cunha T (2016) Endometrial cancer. In: Forstner R, Hamm B (eds) MRI and CT of the female pelvis. Berlin, Springer, p 1–30Google Scholar
- 49.Nakai G, Matsuki M, Inada Y et al (2008) Detection and evaluation of pelvic lymph nodes in patients with gynecologic malignancies using body diffusion-weighted magnetic resonance imaging. J Comput Assist Tomogr 32:764–768Google Scholar
- 51.Flusberg M, Ganeles J, Ekinci T et al (2017) Impact of a structured report template on the quality of CT and MRI reports for hepatocellular carcinoma diagnosis. J Am Coll Radiol 14:1206–1211Google Scholar
- 53.Sahni VA, Silveira PC, Sainani NI, Khorasani R (2015) Impact of a structured report template on the quality of MRI reports for rectal cancer staging. AJR Am J Roentgenol 205:584–588Google Scholar
- 55.Kubik-Huch R, Weston M, Nougaret S et al (2018) European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of leiomyomas. Eur Radiol. https://doi.org/10.1007/s00330-017-5157-5
- 60.group As, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125-136Google Scholar
- 63.Frost JA, Webster KE, Bryant A, Morrison J (2015) Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev CD007585. https://doi.org/ https://doi.org/10.1002/14651858.CD007585.pub3
- 70.Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP (2000) The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 89:1765–1772Google Scholar
- 73.Rechichi G, Galimberti S, Signorelli M et al (2011) Endometrial cancer: correlation of apparent diffusion coefficient with tumor grade, depth of myometrial invasion, and presence of lymph node metastases. AJR Am J Roentgenol 197:256-62Google Scholar
- 75.Takahashi M, Kozawa E, Tanisaka M, Hasegawa K, Yasuda M, Sakai F (2016) Utility of histogram analysis of apparent diffusion coefficient maps obtained using 3.0T MRI for distinguishing uterine carcinosarcoma from endometrial carcinoma. J Magn Reson Imaging 43:1301–1307PubMedPubMedCentralGoogle Scholar
- 85.Wang J, Yu T, Bai R, Sun H, Zhao X, Li Y (2010) The value of the apparent diffusion coefficient in differentiating stage IA endometrial carcinoma from normal endometrium and benign diseases of the endometrium: initial study at 3-T magnetic resonance scanner. J Comput Assist Tomogr 34:332–337PubMedPubMedCentralGoogle Scholar
- 89.Koh WJ, Abu-Rustum NR, Bean S, et al (2018) Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 16:170–199Google Scholar
- 92.MacKay HJ, Levine DA, Bae-Jump VL et al (2017) Moving forward with actionable therapeutic targets and opportunities in endometrial cancer: NCI clinical trials planning meeting report on identifying key genes and molecular pathways for targeted endometrial cancer trials. Oncotarget 8:84579–84594PubMedPubMedCentralGoogle Scholar