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Endometrial Cancer: A Daily Clinical Practice Guide for Radiologists.

Pamela Causa Andrieu1, Giacomo Avesani2, Stanislas Quesada3

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Magnetic Resonance in Medical Sciences : MRMS : an Official Journal of Japan Society of Magnetic Resonance in Medicine
|August 20, 2025
PubMed
Summary
This summary is machine-generated.

Endometrial cancer (EC) is rising, especially in minority groups. The 2023 FIGO staging updates, aided by MRI and PET/CT imaging, improve risk stratification and treatment planning for better patient outcomes.

Keywords:
computed tomographyendometrial neoplasmmagnetic resonance imaging

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Area of Science:

  • Gynecologic Oncology
  • Diagnostic Imaging
  • Cancer Staging

Background:

  • Endometrial cancer (EC) incidence is rising, particularly in non-Hispanic Black, Hispanic, and Asian women, projected to be the third most common cancer by 2040.
  • The International Federation of Gynecology and Obstetrics (FIGO) 2023 classification introduces significant updates for improved risk stratification.
  • Accurate staging and risk assessment are crucial for effective treatment planning and management of endometrial cancer.

Purpose of the Study:

  • To highlight the key updates in the FIGO 2023 classification for endometrial cancer staging.
  • To emphasize the critical role of Magnetic Resonance Imaging (MRI) in evaluating disease extent, treatment planning, and follow-up.
  • To discuss the utility of advanced imaging techniques like 18F-FDG PET/CT and 18F-FDG PET/MRI in detecting metastases and recurrence.

Main Methods:

  • Review of the FIGO 2023 staging guidelines, focusing on revisions related to myometrial invasion, ovarian involvement, and peritoneal spread.
  • Analysis of the role of MRI in assessing local disease, guiding fertility-sparing treatments, and radiotherapy planning.
  • Evaluation of the contribution of CT and 18F-FDG PET/CT or PET/MRI in detecting nodal and distant metastases and recurrence.

Main Results:

  • The FIGO 2023 staging incorporates molecular markers and refined criteria for myometrial invasion, ovarian tumors, and peritoneal disease.
  • MRI is essential for local staging, distinguishing EC from cervical cancer, and guiding treatment decisions, including fertility preservation.
  • 18F-FDG PET/CT and 18F-FDG PET/MRI demonstrate value in detecting metastases and assessing recurrence, with PET/MRI offering an integrated approach.

Conclusions:

  • The updated FIGO 2023 classification enhances endometrial cancer staging accuracy.
  • Advanced imaging, particularly MRI, is indispensable for comprehensive evaluation, treatment planning, and follow-up of endometrial cancer.
  • Integrating molecular markers and advanced imaging modalities like PET/CT and PET/MRI improves the management and monitoring of endometrial cancer, especially in high-risk populations.