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Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To update the 2009 ESUR endometrial cancer guidelines and propose strategies to standardize image acquisition, interpretation and reporting for endometrial cancer staging with MRI.

Methods

The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to 81 questions regarding the details of patient preparation, MR imaging protocol, image interpretation and reporting were collected, analysed and classified as “RECOMMENDED” versus “NOT RECOMMENDED” (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts).

Results

Consensus regarding patient preparation, MR image acquisition, interpretation and reporting was determined using the RAND-UCLA Appropriateness Method. A tailored MR imaging protocol and a standardized report were recommended.

Conclusions

These consensus recommendations should be used as a guide for endometrial cancer staging with MRI.

Key points

• MRI is recommended for initial staging of endometrial cancer.

• MR imaging protocol should be tailored based on the risk of lymph node metastases.

• Myometrial invasion is best assessed using combined axial-oblique T2WI, DWI and contrast-enhanced imaging.

• The mnemonic “Clinical and MRI Critical TEAM” summarizes key elements of the standardized report.

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Abbreviations

CSI:

Cervical stromal invasion

DCE-MRI:

Dynamic contrast-enhanced MRI

DWI:

Diffusion-weighted imaging

EC:

Endometrial cancer

ESMO:

European Society for Medical Oncology

ESUR:

European Society of Urogenital Radiology

FOCUS:

Field of view (FOV) optimized and constrained undistorted single-shot DWI

MI:

Myometrial invasion

MRI:

Magnetic resonance imaging

RAM:

RAND-UCLA Appropriateness Method

SI:

Signal intensity

SLN:

Sentinel lymph node

TA:

Texture analysis

T2WI:

T2-weighted imaging

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Acknowledgements

The committee would like to thank Mr Arnold Stipsits, ESUR secretary, for his help with co-ordination of the committee members. The authors would like to acknowledge the contribution of information specialist Dr. Martina Gosteli (Main library - Medicine Careum, University of Zurich) for her valuable assistance with the database searches. We would like to thank the following colleagues: Henrik Leonhardt, Celine Alt, Federico Collettini, Laure Fournier, Diomidis Botsikas, Gavin Stewart, Athina C. Tsili, Theresa Mokry, Riccardo Manfredi, Laura Bunesch Villalba, Sonya Snape, Hebert Alberto Vargas, Maryna Brochwicz-Lewinski, M. Weston, Suzan M. Goldman and Sara Belião for participating to the questionnaire on behalf of the ESUR women’s imaging group. Authors thank Joanne Chin M.F.A. for her editorial assistance with the manuscript.

Funding

Yulia Lakhman's contribution to this work was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

Author information

Authors and Affiliations

  1. IRCM, Montpellier Cancer Research institute, 208 Ave des Apothicaires, 34295, Montpellier, France

    Stephanie Nougaret

  2. Department of Radiology, Montpellier Cancer institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France

    Stephanie Nougaret

  3. Service de Radiologie, Institut régional du Cancer de Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France

    Stephanie Nougaret

  4. Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisboa Codex, Portugal

    Mariana Horta

  5. Department of Radiology Box 218, Cambridge Biomedical Campus Cambridge, CB2 0QQ, Cambridge, UK

    Evis Sala

  6. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Yulia Lakhman

  7. UPMC Univ. Paris 06, Institut Universitaire de Cancérologie, Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Tenon, Sorbonne Universités, Service de Radiologie, 54 avenue Gambetta, 75020, Paris, France

    Isabelle Thomassin-Naggara

  8. Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Aki Kido

  9. Radiology Department, Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy

    Gabriele Masselli

  10. Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Department of Surgery and Cancer, Imperial College, London. 3rd Floor, Queen Elizabeth the Queen Mother Building, Praed St, London, W21NY, UK

    Nishat Bharwani

  11. Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin SMPH, Madison, WI, USA

    Elizabeth Sadowski

  12. Department of Radiology, Spital Bülach, Spitalstrasse 24, CH-8180, Bülach, Switzerland

    Andrea Ertmer

  13. Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain

    Milagros Otero-Garcia

  14. Department of Radiology, Kantonsspital Baden, Baden, Switzerland

    Rahel A. Kubik-Huch

  15. Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisboa Codex, Portugal

    Teresa M Cunha

  16. The Royal Marsden Hospital NHS Foundation Trust, London, UK

    Andrea Rockall

  17. Imperial College, London, UK

    Andrea Rockall

  18. Department of Radiology Müllner Hauptstr, 48 Universitätsklinikum Salzburg, PMU 5020, Salzburg, Austria

    Rosemarie Forstner

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  1. Stephanie Nougaret
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  2. Mariana Horta
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  4. Yulia Lakhman
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Corresponding author

Correspondence to Stephanie Nougaret.

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The scientific guarantor of this publication is Rosemarie Forstner

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because no patient data were used.

Ethical approval

Institutional review board approval was not required because no patient data were used.

Methodology

• multicentre study

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Nougaret, S., Horta, M., Sala, E. et al. Endometrial Cancer MRI staging: Updated Guidelines of the European Society of Urogenital Radiology. Eur Radiol 29, 792–805 (2019). https://doi.org/10.1007/s00330-018-5515-y

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  • DOI: https://doi.org/10.1007/s00330-018-5515-y

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