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Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology

  • Stephanie Nougaret
  • Mariana Horta
  • Evis Sala
  • Yulia Lakhman
  • Isabelle Thomassin-Naggara
  • Aki Kido
  • Gabriele Masselli
  • Nishat Bharwani
  • Elizabeth Sadowski
  • Andrea Ertmer
  • Milagros Otero-Garcia
  • Rahel A. Kubik-Huch
  • Teresa M Cunha
  • Andrea Rockall
  • Rosemarie Forstner
Magnetic Resonance

Abstract

Objectives

To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI.

Methods

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).

Results

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.

Conclusions

These consensus recommendations should be used as a guide for endometrial cancer staging with MRI.

Key points

• 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.

Keywords

Magnetic resonance imaging Endometrial cancer Guideline Diffusion Uterus 

Abbreviations

CSI

Cervical stromal invasion

DCE-MRI

Dynamic contrast-enhanced MRI

DWI

Diffusion-weighted imaging

EC

Endometrial cancer

ESMO

European Society for Medical Oncology

ESUR

European Society of Urogenital Radiology

FOCUS

Field of view (FOV) optimized and constrained undistorted single-shot DWI

MI

Myometrial invasion

MRI

Magnetic resonance imaging

RAM

RAND-UCLA Appropriateness Method

SI

Signal intensity

SLN

Sentinel lymph node

TA

Texture analysis

T2WI

T2-weighted imaging

Notes

Acknowledgements

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.

Funding

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

Guarantor

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.

Informed consent

Written informed consent was not required for this study because no patient data were used.

Ethical approval

Institutional review board approval was not required because no patient data were used.

Methodology

• multicentre study

Supplementary material

330_2018_5515_MOESM1_ESM.docx (183 kb)
ESM 1 (DOCX 183 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Stephanie Nougaret
    • 1
    • 2
    • 3
  • Mariana Horta
    • 4
  • Evis Sala
    • 5
  • Yulia Lakhman
    • 6
  • Isabelle Thomassin-Naggara
    • 7
  • Aki Kido
    • 8
  • Gabriele Masselli
    • 9
  • Nishat Bharwani
    • 10
  • Elizabeth Sadowski
    • 11
  • Andrea Ertmer
    • 12
  • Milagros Otero-Garcia
    • 13
  • Rahel A. Kubik-Huch
    • 14
  • Teresa M Cunha
    • 15
  • Andrea Rockall
    • 16
    • 17
  • Rosemarie Forstner
    • 18
  1. 1.IRCM, Montpellier Cancer Research instituteMontpellierFrance
  2. 2.Department of Radiology, Montpellier Cancer institute, INSERM, U1194University of MontpellierMontpellierFrance
  3. 3.Service de RadiologieInstitut régional du Cancer de MontpellierMontpellierFrance
  4. 4.Department of RadiologyInstituto Português de Oncologia de Lisboa Francisco GentilLisboa CodexPortugal
  5. 5.Department of Radiology Box 218Cambridge Biomedical Campus CambridgeCambridgeUK
  6. 6.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  7. 7.UPMC Univ. Paris 06, Institut Universitaire de Cancérologie, Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital TenonSorbonne UniversitésParisFrance
  8. 8.Department of Diagnostic Radiology and Nuclear MedicineKyoto University HospitalKyotoJapan
  9. 9.Radiology DepartmentSapienza UniversityRomeItaly
  10. 10.Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS TrustLondonUK
  11. 11.Departments of Radiology, Obstetrics and GynecologyUniversity of Wisconsin SMPHMadisonUSA
  12. 12.Department of RadiologySpital BülachBülachSwitzerland
  13. 13.Complexo Hospitalario Universitario de Santiago de CompostelaSantiago de CompostelaSpain
  14. 14.Department of RadiologyKantonsspital BadenBadenSwitzerland
  15. 15.Department of RadiologyInstituto Português de Oncologia de Lisboa Francisco GentilLisboa CodexPortugal
  16. 16.The Royal Marsden Hospital NHS Foundation TrustLondonUK
  17. 17.Imperial CollegeLondonUK
  18. 18.Department of Radiology Müllner HauptstrSalzburgAustria

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