Therefore, posttherapy surveillance imaging may include evaluation of the abdomen and pelvis. Imaging of the chest may be indicated in selected high-risk, advanced stage patients to detect lung metastasis. Close follow-up after the completion of treatment for EC is suggested, particularly in the first 3 years after diagnosis, when the risk of recurrence is highest [18]. This usually includes a history and physical examination every 3 to 6 months for several years. Vaginal bleeding is a common symptom of local recurrence. In patients with a distant recurrence, symptoms such as coughing, pain, lethargy, weight loss, or headaches are present in up to 70% of cases [19,20]. In one study, a combination of findings at physical examination with or without patient symptomatology, resulted in a >80% recurrence detection rate [21]. Radiologic evaluation such as a CT scan or fluorine-18-2-fluoro- 2-deoxy-D-glucose (FDG)-PET/CT scan of the chest, abdomen, and pelvis should only be used to investigate suspicion of recurrent disease and not for routine surveillance after treatment [22]. Whenever feasible, pathologic diagnosis with biopsy should be done to confirm disease recurrence [23]. Special Imaging Considerations MR perfusion and blood oxygen level dependent MRI do not have established roles in the evaluation of EC [24]. Evaluation and Follow-Up of Endometrial Cancer Certain ECs have demonstrated increased spectroscopic signals from choline, lipids, and lactates [24]. This reaction could be exploited to determine long-term prognosis and treatment response on MR spectroscopy but still needs validation. Magnetic iron oxide nanoparticles or ultra-small particles of iron oxides may demonstrate a potential in detecting malignant pelvic lymph nodes, but these particles are not widely available [25].
Pretreatment Evaluation and Follow Up of Endometrial Cancer. Therefore, posttherapy surveillance imaging may include evaluation of the abdomen and pelvis. Imaging of the chest may be indicated in selected high-risk, advanced stage patients to detect lung metastasis. Close follow-up after the completion of treatment for EC is suggested, particularly in the first 3 years after diagnosis, when the risk of recurrence is highest [18]. This usually includes a history and physical examination every 3 to 6 months for several years. Vaginal bleeding is a common symptom of local recurrence. In patients with a distant recurrence, symptoms such as coughing, pain, lethargy, weight loss, or headaches are present in up to 70% of cases [19,20]. In one study, a combination of findings at physical examination with or without patient symptomatology, resulted in a >80% recurrence detection rate [21]. Radiologic evaluation such as a CT scan or fluorine-18-2-fluoro- 2-deoxy-D-glucose (FDG)-PET/CT scan of the chest, abdomen, and pelvis should only be used to investigate suspicion of recurrent disease and not for routine surveillance after treatment [22]. Whenever feasible, pathologic diagnosis with biopsy should be done to confirm disease recurrence [23]. Special Imaging Considerations MR perfusion and blood oxygen level dependent MRI do not have established roles in the evaluation of EC [24]. Evaluation and Follow-Up of Endometrial Cancer Certain ECs have demonstrated increased spectroscopic signals from choline, lipids, and lactates [24]. This reaction could be exploited to determine long-term prognosis and treatment response on MR spectroscopy but still needs validation. Magnetic iron oxide nanoparticles or ultra-small particles of iron oxides may demonstrate a potential in detecting malignant pelvic lymph nodes, but these particles are not widely available [25].