If distant metastatic disease is clinically suspected, preoperative assessment of metastatic disease with contrast-enhanced CT is indicated. However, most patients with low-grade disease are at low risk of lymph node and distant metastases. Thus, this group does not require a routine pretreatment evaluation for distant metastases by CT imaging. FDG-PET/CT Skull Base to Mid-Thigh The role of PET in EC imaging is evolving. Recently, a meta-analysis reported that the overall pooled sensitivity, specificity, and accuracy of using FDG-PET/CT for detection of lymph node metastasis in EC was 72.0%, 94.0%, and 88.0%, respectively [73]. Although this meta-analysis found the overall sensitivity of FDG-PET/CT to be moderate for the detection of lymph node metastasis in EC, it compares favorably with the reported sensitivities for lymph node metastasis detection by conventional MRI and CT. However, because 45% of ECs are grade 1 and not particularly FDG-avid, the routine use of FDG-PET in preoperative staging in early stage disease is not recommended, but FDG-PET may be used in patients in which distant metastases is clinically suspected [19,74]. Lymphangiography Pelvis Lymphangiography pelvis is not helpful for evaluating cancer of the endometrium because 1) it is invasive, and 2) its performance for assessing pelvic lymph nodes is not reproducible and the accuracy is slightly inferior to that of CT and MRI [75]. MRI Abdomen If distant metastasis to other abdominal organs (eg, liver) is clinically suspected, abdominal MRI or CT may be performed. However, patients in this group are at low risk for distant metastases [80]. US Pelvis Transabdominal The combination of morphological and vascular patterns of lymph nodes using transabdominal US can be used to differentiate metastatic from normal or reactive nodes [81]. However, visualization of retroperitoneal or iliac lymph nodes can be limited using US because of patient body habitus and overlying bowel gas.
Pretreatment Evaluation and Follow Up of Endometrial Cancer. If distant metastatic disease is clinically suspected, preoperative assessment of metastatic disease with contrast-enhanced CT is indicated. However, most patients with low-grade disease are at low risk of lymph node and distant metastases. Thus, this group does not require a routine pretreatment evaluation for distant metastases by CT imaging. FDG-PET/CT Skull Base to Mid-Thigh The role of PET in EC imaging is evolving. Recently, a meta-analysis reported that the overall pooled sensitivity, specificity, and accuracy of using FDG-PET/CT for detection of lymph node metastasis in EC was 72.0%, 94.0%, and 88.0%, respectively [73]. Although this meta-analysis found the overall sensitivity of FDG-PET/CT to be moderate for the detection of lymph node metastasis in EC, it compares favorably with the reported sensitivities for lymph node metastasis detection by conventional MRI and CT. However, because 45% of ECs are grade 1 and not particularly FDG-avid, the routine use of FDG-PET in preoperative staging in early stage disease is not recommended, but FDG-PET may be used in patients in which distant metastases is clinically suspected [19,74]. Lymphangiography Pelvis Lymphangiography pelvis is not helpful for evaluating cancer of the endometrium because 1) it is invasive, and 2) its performance for assessing pelvic lymph nodes is not reproducible and the accuracy is slightly inferior to that of CT and MRI [75]. MRI Abdomen If distant metastasis to other abdominal organs (eg, liver) is clinically suspected, abdominal MRI or CT may be performed. However, patients in this group are at low risk for distant metastases [80]. US Pelvis Transabdominal The combination of morphological and vascular patterns of lymph nodes using transabdominal US can be used to differentiate metastatic from normal or reactive nodes [81]. However, visualization of retroperitoneal or iliac lymph nodes can be limited using US because of patient body habitus and overlying bowel gas.