FIGO 2025 Gynecologic Cancers: An Ultrasound-Focused Imaging Update

The 2025 FIGO Cancer Report updates recommendations for the diagnosis, staging, and management of the 6 major gynecologic malignancies, including cervical, endometrial, vaginal, vulvar, ovarian, and fallopian tube cancer, and gestational trophoblastic disease (GTD). The role of ultrasound differs considerably across the 6 cancers. In cases of endometrial and GTD, ultrasound is used to guide initial diagnosis, risk stratification, and surgical planning. In postmenopausal bleeding, a transvaginal ultrasound can assess endometrial thickness and determine the need for further evaluation. In cervical cancer, transrectal ultrasound allows local tumor assessment and brachytherapy guidance. Ovarian and fallopian tube cancers rely on ultrasound as the first-line tool for adnexal mass assessment and contribute to the Risk of Malignancy Index. For vaginal cancer, sonography has a complementary role in the anatomic assessment of the primary tumor. In vulvar cancer, ultrasound use is limited, as it is mainly for lymph node evaluation in early disease, when used in conjunction with clinical examination and cross-sectional imaging. Although ultrasound has limitations when assessing nodal spread or distant metastases, it can be used in combination with cross-sectional imaging and serial biomarkers to provide a complete evaluation. This review aims to summarize the ultrasound-relevant content from the 2025 FIGO update reports and serve as a practical reference for radiologists.