 Introduction/Background Accurate pretreatment evaluation of endometrial carcinoma (EC) may optimize therapy, particularly with regard to choosing the type of surgery. Preoperative imaging of EC can define the extent of disease and indicate the need for subspecialist referral in the presence of deep myometrial invasion, cervical extension, suspected lymphadenopathy or if high-grade endometrioid carcinoma or high-risk histology (such as papillary serous or clear cell carcinoma) is found at the time of biopsy. Cross-sectional imaging techniques play a vital role in the pretreatment assessment of uterine cancers and should be viewed as complementary modalities for surgical evaluation of these patients. The depth of myometrial invasion, cervical stromal invasion, local regional invasion of pelvic structures, and distant metastasis can be readily detected at cross-sectional imaging. Although ultrasound (US) remains the imaging modality of choice to screen women who have suspected EC, state-of-the-art dynamic contrast-enhanced and diffusion-weighted imaging (DWI) MR techniques are better suited to preoperatively stage, identify recurrence, and assess local treatment response in women with EC. Initial Staging EC is the most common gynecologic malignancy in the United States, with approximately 61,880 newly diagnosed cases and 12,160 deaths expected in 2019 [1]. Histopathologically, ECs are classified as type I (>80%) and type II (<20%) [2]. Type I tumors are typically endometrioid in histology and estrogen-dependent. They are often low- grade (grade 1 and 2) preceded by a premalignant endometrial hyperplasia and are associated with a better prognosis. Type II tumors tend to be nonestrogen dependent, nonendometrioid, high-grade endometrioid tumors (grade 3), and characteristically arise from an atrophic endometrium. They demonstrate a worse prognosis and are responsible for almost half of the EC-related deaths [3].
Pretreatment Evaluation and Follow Up of Endometrial Cancer.  Introduction/Background Accurate pretreatment evaluation of endometrial carcinoma (EC) may optimize therapy, particularly with regard to choosing the type of surgery. Preoperative imaging of EC can define the extent of disease and indicate the need for subspecialist referral in the presence of deep myometrial invasion, cervical extension, suspected lymphadenopathy or if high-grade endometrioid carcinoma or high-risk histology (such as papillary serous or clear cell carcinoma) is found at the time of biopsy. Cross-sectional imaging techniques play a vital role in the pretreatment assessment of uterine cancers and should be viewed as complementary modalities for surgical evaluation of these patients. The depth of myometrial invasion, cervical stromal invasion, local regional invasion of pelvic structures, and distant metastasis can be readily detected at cross-sectional imaging. Although ultrasound (US) remains the imaging modality of choice to screen women who have suspected EC, state-of-the-art dynamic contrast-enhanced and diffusion-weighted imaging (DWI) MR techniques are better suited to preoperatively stage, identify recurrence, and assess local treatment response in women with EC. Initial Staging EC is the most common gynecologic malignancy in the United States, with approximately 61,880 newly diagnosed cases and 12,160 deaths expected in 2019 [1]. Histopathologically, ECs are classified as type I (>80%) and type II (<20%) [2]. Type I tumors are typically endometrioid in histology and estrogen-dependent. They are often low- grade (grade 1 and 2) preceded by a premalignant endometrial hyperplasia and are associated with a better prognosis. Type II tumors tend to be nonestrogen dependent, nonendometrioid, high-grade endometrioid tumors (grade 3), and characteristically arise from an atrophic endometrium. They demonstrate a worse prognosis and are responsible for almost half of the EC-related deaths [3].