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ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer

Lalwani, Neeraj MD*; Dubinsky, Theodore MD*; Javitt, Marcia C. MD; Gaffney, David K. MD, PhD; Glanc, Phyllis MD§; Elshaikh, Mohamed A. MD; Kim, Young Bae MD; Lee, Larissa J. MD#; Pannu, Harpreet K. MD**; Royal, Henry D. MD††; Shipp, Thomas D. MD‡‡; Siegel, Cary Lynn MD§§; Simpson, Lynn MD∥∥; Wahl, Andrew O. MD¶¶; Wolfson, Aaron H. MD##; Zelop, Carolyn M. MD***

doi: 10.1097/RUQ.0000000000000068
ACR Appropriateness Criteria

Endometrial cancer is the most common gynecologic and the fourth most common malignancy in women in the United States. Cross-sectional imaging plays a vital role in pretreatment assessment of endometrial cancers and should be viewed as a complementary tool for surgical evaluation and planning of these patients. Although transvaginal US remains the preferred examination for the screening purposes, MRI has emerged as the modality of choice for the staging of endometrial cancer and imaging assessment of recurrence or treatment response. A combination of dynamic contrast-enhanced and diffusion weighted MRI provides the highest accuracy for the staging. Both CT and MRI perform equivalently for assessing nodal involvement or distant metastasis. PET-CT is more appropriate for assessing lymphadenopathy in high-grade FDG-avid tumors or for clinically suspected recurrence after treatment. An appropriate use and guidelines of imaging techniques in diagnosis, staging, and detection of endometrial cancer and treatment of recurrent disease are reviewed.

The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

*University of Washington School of Medicine, Seattle, Washington; †Walter Reed National Military Medical Center, Bethesda, Maryland; ‡University of Utah Medical Center, Salt Lake City, Utah; §Sunnybrook Health Sciences Centre, Bayview Campus, Toronto, Ontario, Canada; ∥Henry Ford Health System, Detroit, Michigan; ¶Tufts Medical Center, Boston, Massachusetts, Society of Gynecologic Oncologists; #Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; **Memorial Sloan Kettering Cancer Center, New York, New York; ††Mallinckrodt Institute of Radiology, St. Louis, Missouri, Society of Nuclear Medicine and Molecular Imaging; ‡‡Brigham & Women’s Hospital, Boston, Massachusetts, American College of Obstetrics and Gynecology; §§Mallinckrodt Institute of Radiology, St. Louis, Missouri; ∥∥Columbia University, New York, New York, American College of Obstetrics and Gynecology; ¶¶University of Nebraska Medical Center, Omaha, Nebraska; ##University of Miami, Miami, Florida; and ***Valley Hospital, Ridgewood, New Jersey, American College of Obstetrics and Gynecology.

Received for publication November 6, 2013; accepted January 9, 2014.

The authors declare no conflict of interest.

The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.

Reprint requests to: Department of Quality & Safety, American College of Radiology, 1891 Preston White Drive, Reston, VA 20191-4397.

Corresponding author information: Neeraj Lalwani, MD, Assistant Professor, Department of Radiology(Body Imaging), University of Washington, Box 359728, 325 9th Ave, Seattle, WA, USA 98104-2499 (e-mail:

© 2014 by Lippincott Williams & Wilkins