CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(02): 137-147
DOI: 10.4103/0971-3026.155857
Imaging in Oncology: Recent Advances

Imaging in endometrial carcinoma

Silvana C Faria
Department of Diagnostic Radiology, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
Tara Sagebiel
Department of Diagnostic Radiology, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
Aparna Balachandran
Department of Diagnostic Radiology, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
Catherine Devine
Department of Diagnostic Radiology, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
Chandana Lal
Department of Diagnostic Radiology, UC Irvine Health, Irvine, California, USA
Priya R Bhosale
Department of Diagnostic Radiology, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
› Author Affiliations


Endometrial carcinoma (EC) is the most common gynecologic malignancy in the United States. Prognosis depends on patient age, histological grade, depth of myometrial invasion and/or cervical invasion, and the presence of lymph node metastases. Although EC is staged surgically according to the International Federation of Gynecology and Obstetrics (FIGO) system, preoperative imaging can assist in optimal treatment planning. Several imaging techniques such as transvaginal ultrasonography (TVUS), computed tomography (CT), and magnetic resonance imaging (MRI) have been used as diagnostic tools for preoperative staging of EC. Recently, positron emission tomography (PET), PET/CT, and PET/MRI have also been used in staging these patients. In this article, we review the value of imaging in diagnosis, staging, treatment planning, and detection of recurrent disease in patients with EC.

Publication History

Publication Date:
30 July 2021 (online)

© 2015. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29.
  • 2 Balasubramaniam G, Sushama S, Rasika B, Mahantshetty U. Hospital-based study of endometrial cancer survival in Mumbai, India. Asian Pac J Cancer Prev 2013;14:977-80.
  • 3 Arora V, Quinn MA. Endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2012;26:311-24.
  • 4 Wright JD, Barrena Medel NI, Sehouli J, Fujiwara K, Herzog TJ. Contemporary management of endometrial cancer. Lancet 2012;379 (9823):1352-60.
  • 5 Tirumani SH, Shanbhogue AK, Prasad SR. Current concepts in the diagnosis and management of endometrial and cervical carcinomas. Radiol Clin North Am 2013;51:1087-110.
  • 6 Fadare O, Gwin K, Desouki MM, Crispens MA, Jones HW 3 rd , Khabele D, et al. The clinicopathologic significance of p53 and BAF-250a (ARID1A) expression in clear cell carcinoma of the endometrium. Mod Pathol 2013;26:1101-10.
  • 7 Attias-Geva Z, Bentov I, Kidron D, Amichay K, Sarfstein R, Fishman A, et al. p53 Regulates insulin-like growth factor-I receptor gene expression in uterine serous carcinoma and predicts responsiveness to an insulin-like growth factor-I receptor-directed targeted therapy. Eur J Cancer 2012;48:1570-80.
  • 8 Steinbakk A, Malpica A, Slewa A, Skaland I, Gudlaugsson E, Janssen EA, et al. Biomarkers and microsatellite instability analysis of curettings can predict the behavior of FIGO stage I endometrial endometrioid adenocarcinoma. Mod Pathol 2011;24:1262-71.
  • 9 Minaguchi T, Yoshikawa H, Oda K, Ishino T, Yasugi T, Onda T, et al. PTEN mutation located only outside exons 5, 6, and 7 is an independent predictor of favorable survival in endometrial carcinomas. Clin Cancer Res 2001;7:2636-42.
  • 10 Santin AD, Bellone S, Van Stedum S, Bushen W, Palmieri M, Siegel ER, et al. Amplification of c-erbB2 oncogene: A major prognostic indicator in uterine serous papillary carcinoma. Cancer 2005;104:1391-7.
  • 11 Sorosky JI. Endometrial cancer. Obstet Gynecol 2012;120:383-97.
  • 12 Ascher SM, Reinhold C. Imaging of cancer of the endometrium. Radiol Clin North Am 2002;40:563-76.
  • 13 Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet. 2009;105:109.
  • 14 Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. American Joint Committee on Cancer. American Joint Committee on Cancer Staging Manual. 7 th ed. New York: Springer; 2010. p. 403-18.
  • 15 Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998;280:1510-7.
  • 16 Epstein E, Blomqvist L. Imaging in endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2014;28:721-39.
  • 17 Takac I. Transvaginal ultrasonography with and without saline infusion in assessment of myometrial invasion of endometrial cancer. J Ultrasound Med 2007;26:949-57.
  • 18 Dessole S, Rubattu G, Farina M, Capobianco G, Cherchi PL, Tanda F, et al. Risks and usefulness of sonohysterography in patients with endometrial carcinoma. Am J Obstet Gynecol 2006;194:362-8.
  • 19 Barwick TD, Rockall AG, Barton DP, Sohaib SA. Imaging of endometrial adenocarcinoma. Clin Radiol 2006;61:545-55.
  • 20 Sladkevicius P, Valentin L, Marsál K. Endometrial thickness and Doppler velocimetry of the uterine arteries as discriminators of endometrial status in women with postmenopausal bleeding: A comparative study. Am J Obstet Gynecol 1994;171:722-8.
  • 21 Hardesty LA, Sumkin JH, Hakim C, Johns C, Nath M. The ability of helical CT to preoperatively stage endometrial carcinoma. AJR Am J Roentgenol 2001;176:603-6.
  • 22 Tsili AC, Tsampoulas C, Dalkalitsis N, Stefanou D, Paraskevaidis E, Efremidis SC. Local staging of endometrial carcinoma: Role of multidetector CT. Eur Radiol 2008;18:1043-8.
  • 23 Akin O, Mironov S, Pandit-Taskar N, Hann LE. Imaging of uterine cancer. Radiol Clin North Am 2007;45:167-82.
  • 24 Hirano Y, Kubo K, Hirai Y, Okada S, Yamada K, Sawano S, et al. Preliminary experience with gadolinium-enhanced dynamic MR imaging for uterine neoplasms. Radiographics 1992;12:243-56.
  • 25 Hricak H, Rubinstein LV, Gherman GM, Karstaedt N. MR imaging evaluation of endometrial carcinoma: Results of an NCI cooperative study. Radiology 1991;179:829-32.
  • 26 Lien HH, Blomlie V, Tropé C, Kaern J, Abeler VM. Cancer of the endometrium: Value of MR imaging in determining depth of invasion into the myometrium. AJR Am J Roentgenol 1991;157:1221-3.
  • 27 Manfredi R, Mirk P, Maresca G, Margariti PA, Testa A, Zannoni GF, et al. Local-regional staging of endometrial carcinoma: Role of MR imaging in surgical planning. Radiology 2004;231:372-8.
  • 28 Beddy P, O′Neill AC, Yamamoto AK, Addley HC, Reinhold C, Sala E. FIGO staging system for endometrial cancer: Added benefits of MR imaging. Radiographics 2012;32:241-54.
  • 29 Foti PV, Farina R, Coronella M, Ruggeri C, Palmucci S, Montana A, et al. Endometrial carcinoma: MR staging and causes of error. Radiol Med 2013;118:487-503.
  • 30 Freeman SJ, Aly AM, Kataoka MY, Addley HC, Reinhold C, Sala E. The revised FIGO staging system for uterine malignancies: Implications for MR imaging. Radiographics 2012;32:1805-27.
  • 31 Wu WJ, Yu MS, Su HY, Lin KS, Lu KL, Hwang KS. The accuracy of magnetic resonance imaging for preoperative deep myometrium assessment in endometrial cancer. Taiwan J Obstet Gynecol 2013;52:210-4.
  • 32 Peungjesada S, Bhosale PR, Balachandran A, Iyer RB. Magnetic resonance imaging of endometrial carcinoma. J Comput Assist Tomogr 2009;33:601-8.
  • 33 Haldorsen IS, Husby JA, Werner HM, Magnussen IJ, Rørvik J, Helland H, et al. Standard 1.5-T MRI of endometrial carcinomas: Modest agreement between radiologists. Eur Radiol 2012;22:1601-11.
  • 34 Murakami T, Kurachi H, Nakamura H, Tsuda K, Miyake A, Tomoda K, et al. Cervical invasion of endometrial carcinoma-evaluation by parasagittal MR imaging. Acta Radiol 1995;36:248-53.
  • 35 Takahashi K, Yoshioka M, Kosuge H, Iizuka Y, Musha T, Yamauchi I, et al. The accuracy of computed tomography and magnetic resonance imaging in evaluating the extent of endometrial carcinoma. Nihon Sanka Fujinka Gakkai Zasshi 1995;47:647-54.
  • 36 Petru E, Lück HJ, Stuart G, Gaffney D, Millan D, Vergote I; Gynecologic Cancer Intergroup (GCIG). Gynecologic Cancer Intergroup (GCIG) proposals for changes of the current FIGO staging system. Eur J Obstet Gynecol Reprod Biol 2009;143:69-74.
  • 37 Kang S, Todo Y, Watari H. Risk assessment of lymph node metastasis before surgery in endometrial cancer: Do we need a clinical trial for low-risk patients? J Obstet Gynaecol Res 2014;40:322-6.
  • 38 Todo Y, Watari H, Kang S, Sakuragi N. Tailoring lymphadenectomy according to the risk of lymph node metastasis in endometrial cancer. J Obstet Gynaecol Res 2014;40:317-21.
  • 39 Rockall AG, Meroni R, Sohaib SA, Reynolds K, Alexander-Sefre F, Shepherd JH, et al. Evaluation of endometrial carcinoma on magnetic resonance imaging. Int J Gynecol Cancer 2007;17:188-96.
  • 40 Rockall AG, Sohaib SA, Harisinghani MG, Babar SA, Singh N, Jeyarajah AR, et al. Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer. J Clin Oncol 2005;23:2813-21.
  • 41 Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: What the radiologist needs to know. Radiology 2013;266:717-40.
  • 42 Rechichi G, Galimberti S, Signorelli M, Perego P, Valsecchi MG, Sironi S. Myometrial invasion in endometrial cancer: Diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol 2010;20:754-62.
  • 43 Gallego JC, Porta A, Pardo MC, Fernández C. Evaluation of myometrial invasion in endometrial cancer: Comparison of diffusion-weighted magnetic resonance and intraoperative frozen sections. Abdom Imaging 2014;39:1021-6.
  • 44 Andreano A, Rechichi G, Rebora P, Sironi S, Valsecchi MG, Galimberti S. MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: A systematic review and meta-analysis. Eur Radiol 2014;24:1327-38.
  • 45 Kitajima K, Murakami K, Kaji Y, Sugimura K. Spectrum of FDG PET/CT findings of uterine tumors. AJR Am J Roentgenol 2010;195:737-43.
  • 46 Brunetti J. PET/CT in gynecologic malignancies. Radiol Clin North Am 2013;51:895-911.
  • 47 Ghooshkhanei H, Treglia G, Sabouri G, Davoodi R, Sadeghi R. Risk stratification and prognosis determination using (18) F-FDG PET imaging in endometrial cancer patients: A systematic review and meta-analysis. Gynecol Oncol 2014;132:669-76.
  • 48 Kitajima K, Murakami K, Yamasaki E, Kaji Y, Sugimura K. Accuracy of integrated FDG-PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer. Eur Radiol 2009;19:1529-36.
  • 49 Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, et al. Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer. Gynecol Oncol 2008;108:486-92.
  • 50 Kitajima K, Yamasaki E, Kaji Y, Murakami K, Sugimura K. Comparison of DWI and PET/CT in evaluation of lymph node metastasis in uterine cancer. World J Radiol 2012;4:207-14.
  • 51 Kitajima K, Murakami K, Yamasaki E, Domeki Y, Kaji Y, Morita S, et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent uterine cancer: Comparison with PET and enhanced CT. Eur J Nucl Med Mol Imaging 2009;36:362-72.
  • 52 Kuhn FP, Hüllner M, Mader CE, Kastrinidis N, Huber GF, von Schulthess GK, et al. Contrast-enhanced PET/MR imaging versus contrast-enhanced PET/CT in head and neck cancer: How much MR information is needed? J Nucl Med 2014;55:551-8.
  • 53 Queiroz MA, Hüllner M, Kuhn F, Huber G, Meerwein C, Kollias S, et al. PET/MRI and PET/CT in follow-up of head and neck cancer patients. Eur J Nucl Med Mol Imaging 2014;41:1066-75.
  • 54 Kitajima K, Suenaga Y, Ueno Y, Kanda T, Maeda T, Takahashi S, et al. Value of fusion of PET and MRI for staging of endometrial cancer: Comparison with 18 F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI. Eur J Radiol 2013;82:1672-6.
  • 55 Kehoe SM, Miller DS. The role of lymphadenectomy in endometrial cancer. Clin Obstet Gynecol 2011;54:235-44.
  • 56 Carlson MJ, Thiel KW, Leslie KK. Past, present, and future of hormonal therapy in recurrent endometrial cancer. Int J Womens Health 2014;6:429-35.
  • 57 Sugimura K, Okizuka H. Postsurgical pelvis: Treatment follow-up. Radiol Clin North Am 2002;40:659-80.
  • 58 Ozcan Kara P, Kara T, Kaya B, Kara Gedik G, Sari O. The value of FDG-PET/CT in the post-treatment evaluation of endometrial carcinoma: A comparison of PET/CT findings with conventional imaging and CA 125 as a tumour marker. Rev Esp Med Nucl Imagen Mol 2012;31:257-60.
  • 59 Sohaib SA, Houghton SL, Meroni R, Rockall AG, Blake P, Reznek RH. Recurrent endometrial cancer: Patterns of recurrent disease and assessment of prognosis. Clin Radiol 2007;62:28-36.
  • 60 Kadkhodayan S, Shahriari S, Treglia G, Yousefi Z, Sadeghi R. Accuracy of 18-F-FDG PET imaging in the follow up of endometrial cancer patients: Systematic review and meta-analysis of the literature. Gynecol Oncol 2013;128:397-404.