Patients with EC typically present with stage I disease (80% of cases), and the recommended treatment is complete resection of disease by hysterectomy and bilateral salpingo-oophorectomy. Multiple studies have demonstrated that recurrence risk after treatment is related to the depth of myometrial invasion, tumor grade, histological subtype, and Reprint requests to: publications@acr.org Evaluation and Follow-Up of Endometrial Cancer lymphovascular space invasion in clinically proven stage I [7]. Risk stratification systems that aggregate these prognostic factors to define recurrence risk groups have been developed and are now used worldwide to guide decision-making and design clinical trials [2,8-10]. Results of a 2014 study of a simultaneous comparison of several proposed risk stratification systems suggested that the European Society for Medical Oncology modified system was the most accurate in the prediction of lymph node status and survival [10]. In that system, categorization of risk grouping was based on FIGO stage, tumor grade, histological subtype, and lymphovascular space invasion. Patients with disease of FIGO stage IB grade 3 endometrioid type with positive lymphovascular space invasion or nonendometrioid histology of all stages can be classified as high risk. Conversely, patients with FIGO stage IA with grade 1 to 2 EC and no lymphovascular space invasion can be classified as low risk. All other tumors can be classified as intermediate or high-intermediate risk. This risk stratification system also guides the need and extent of lymph node sampling for initial staging [9]. Surveillance and Posttherapy Evaluation EC tends to recur in the pelvis, especially in the vaginal vault (42% of recurrences) and pelvic lymph nodes, followed by para-aortic lymph nodes [16]. Extrapelvic recurrence commonly involves the peritoneum and lungs. Atypical metastatic sites include extra-abdominal lymph nodes, liver, adrenals, brain, bones, and soft-tissue [17].
Pretreatment Evaluation and Follow Up of Endometrial Cancer. Patients with EC typically present with stage I disease (80% of cases), and the recommended treatment is complete resection of disease by hysterectomy and bilateral salpingo-oophorectomy. Multiple studies have demonstrated that recurrence risk after treatment is related to the depth of myometrial invasion, tumor grade, histological subtype, and Reprint requests to: publications@acr.org Evaluation and Follow-Up of Endometrial Cancer lymphovascular space invasion in clinically proven stage I [7]. Risk stratification systems that aggregate these prognostic factors to define recurrence risk groups have been developed and are now used worldwide to guide decision-making and design clinical trials [2,8-10]. Results of a 2014 study of a simultaneous comparison of several proposed risk stratification systems suggested that the European Society for Medical Oncology modified system was the most accurate in the prediction of lymph node status and survival [10]. In that system, categorization of risk grouping was based on FIGO stage, tumor grade, histological subtype, and lymphovascular space invasion. Patients with disease of FIGO stage IB grade 3 endometrioid type with positive lymphovascular space invasion or nonendometrioid histology of all stages can be classified as high risk. Conversely, patients with FIGO stage IA with grade 1 to 2 EC and no lymphovascular space invasion can be classified as low risk. All other tumors can be classified as intermediate or high-intermediate risk. This risk stratification system also guides the need and extent of lymph node sampling for initial staging [9]. Surveillance and Posttherapy Evaluation EC tends to recur in the pelvis, especially in the vaginal vault (42% of recurrences) and pelvic lymph nodes, followed by para-aortic lymph nodes [16]. Extrapelvic recurrence commonly involves the peritoneum and lungs. Atypical metastatic sites include extra-abdominal lymph nodes, liver, adrenals, brain, bones, and soft-tissue [17].