Suspicious inguinal lymph nodes can be readily assessed by US and biopsied as needed. US Abdomen Transabdominal US can be used to detect abdominal organ metastasis. However, most patients with low-grade disease are at low risk of lymph node and distant metastases and thus may not require routine pretreatment evaluation by US imaging. Variant 3: Initial staging of pretreatment endometrial cancer; assessment of lymph node and distant metastasis for high-grade tumor (Type I, grade 3 and Type II). In a recent series, nodal metastases have been depicted in up to 29% of patients in intermediate- to high-risk categories [82]. In a study of 55 patients with EC with distant metastasis, 47.2% of patients had a type II tumor [83]. CT Chest, Abdomen, and Pelvis Contrast-enhanced CT of the abdomen and pelvis may be employed preoperatively for the detection of lymph node metastases in this group. However, the reported sensitivity of contrast-enhanced CT for pelvic and para-aortic lymphadenopathy is only 30% to 57%; meanwhile, the reported specificity of contrast-enhanced CT is 92% to 98% [41,71,72]. If distant metastatic disease is clinically suspected, preoperative assessment of metastatic disease with contrast-enhanced CT is indicated [37]. Lymphangiography Pelvis Lymphangiography pelvis is not recommended 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 even when performed optimally [75]. MRI Abdomen If distant metastasis to other abdominal organs (eg, liver) is clinically suspected, abdominal MRI or CT may be performed. 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, there is insufficient data to allow comparison of this procedure to CT or MRI.
Pretreatment Evaluation and Follow Up of Endometrial Cancer. Suspicious inguinal lymph nodes can be readily assessed by US and biopsied as needed. US Abdomen Transabdominal US can be used to detect abdominal organ metastasis. However, most patients with low-grade disease are at low risk of lymph node and distant metastases and thus may not require routine pretreatment evaluation by US imaging. Variant 3: Initial staging of pretreatment endometrial cancer; assessment of lymph node and distant metastasis for high-grade tumor (Type I, grade 3 and Type II). In a recent series, nodal metastases have been depicted in up to 29% of patients in intermediate- to high-risk categories [82]. In a study of 55 patients with EC with distant metastasis, 47.2% of patients had a type II tumor [83]. CT Chest, Abdomen, and Pelvis Contrast-enhanced CT of the abdomen and pelvis may be employed preoperatively for the detection of lymph node metastases in this group. However, the reported sensitivity of contrast-enhanced CT for pelvic and para-aortic lymphadenopathy is only 30% to 57%; meanwhile, the reported specificity of contrast-enhanced CT is 92% to 98% [41,71,72]. If distant metastatic disease is clinically suspected, preoperative assessment of metastatic disease with contrast-enhanced CT is indicated [37]. Lymphangiography Pelvis Lymphangiography pelvis is not recommended 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 even when performed optimally [75]. MRI Abdomen If distant metastasis to other abdominal organs (eg, liver) is clinically suspected, abdominal MRI or CT may be performed. 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, there is insufficient data to allow comparison of this procedure to CT or MRI.