[CT in the evaluation and treatment of endometrial carcinoma (author's transl)]

The prognosis and treatment of patients with endometrial carcinoma are dependent on the clinically established extent of the tumor (stage). The grade of the tumor and depth of myometrial invasion have the most significant prognostic and therapeutic value after the stage. Unfortunately, staging based on pelvic examination is inaccurate in endometrial carcinoma and the depth of myometrial invasion cannot be assessed preoperatively. To stage the disease precisely and to evaluate the extent of myometrial invasion preoperatively, computed tomography (CT) was performed in 20 untreated patients with endometrial carcinoma who subsequently underwent surgery. The CT findings were correlated with the surgical and pathological findings. The tumor appeared as areas of decreased attenuation on CT in comparison with the surrounding myometrium after contrast infusion. Thus, it was easy to evaluate the depth of myometrial invasion on enhanced CT. CT showed the tumor invading less than half the thickness of the myometrium in 13 patients and this was histologically confirmed in all. There were 7 patients with the tumor invading more than half the thickness of the myometrium but confined to the uterus on CT. The CT findings were also histologically confirmed in all patients. CT showed the tumor involving the cervix in 5 patients. This was histologically confirmed in all. No cervical involvement was demonstrated by CT in the remaining 15 patients. Subsequent pathological examination revealed microscopic invasion to the endocervix in 2 cases and no cervical involvement in the other 13. The present study has demonstrated that CT is useful to assess the extent of endometrial cancer; especially useful to evaluate the depth of myometrial involvement. Such information provided by CT helps to plan treatment more adequately and accurately for the individual patients.