Lalwani Neeraj, Dubinsky Theodore, Javitt Marcia C, Gaffney David K, Glanc Phyllis, Elshaikh Mohamed A, Kim Young Bae, Lee Larissa J, Pannu Harpreet K, Royal Henry D, Shipp Thomas D, Siegel Cary Lynn, Simpson Lynn, Wahl Andrew O, Wolfson Aaron H, Zelop Carolyn M
*University of Washington School of Medicine, Seattle, Washington; †Walter Reed National Military Medical Center, Bethesda, Maryland; ‡University of Utah Medical Center, Salt Lake City, Utah; §Sunnybrook Health Sciences Centre, Bayview Campus, Toronto, Ontario, Canada; ∥Henry Ford Health System, Detroit, Michigan; ¶Tufts Medical Center, Boston, Massachusetts, Society of Gynecologic Oncologists; #Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; **Memorial Sloan Kettering Cancer Center, New York, New York; ††Mallinckrodt Institute of Radiology, St. Louis, Missouri, Society of Nuclear Medicine and Molecular Imaging; ‡‡Brigham & Women's Hospital, Boston, Massachusetts, American College of Obstetrics and Gynecology; §§Mallinckrodt Institute of Radiology, St. Louis, Missouri; ∥∥Columbia University, New York, New York, American College of Obstetrics and Gynecology; ¶¶University of Nebraska Medical Center, Omaha, Nebraska; ##University of Miami, Miami, Florida; and ***Valley Hospital, Ridgewood, New Jersey, American College of Obstetrics and Gynecology.
Ultrasound Q. 2014 Mar;30(1):21-8. doi: 10.1097/RUQ.0000000000000068.
Endometrial cancer is the most common gynecologic and the fourth most common malignancy in women in the United States. Cross-sectional imaging plays a vital role in pretreatment assessment of endometrial cancers and should be viewed as a complementary tool for surgical evaluation and planning of these patients. Although transvaginal US remains the preferred examination for the screening purposes, MRI has emerged as the modality of choice for the staging of endometrial cancer and imaging assessment of recurrence or treatment response. A combination of dynamic contrast-enhanced and diffusion weighted MRI provides the highest accuracy for the staging. Both CT and MRI perform equivalently for assessing nodal involvement or distant metastasis. PET-CT is more appropriate for assessing lymphadenopathy in high-grade FDG-avid tumors or for clinically suspected recurrence after treatment. An appropriate use and guidelines of imaging techniques in diagnosis, staging, and detection of endometrial cancer and treatment of recurrent disease are reviewed.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
子宫内膜癌是美国女性中最常见的妇科癌症，也是第四大常见恶性肿瘤。横断面成像在子宫内膜癌的术前评估中起着至关重要的作用，应被视为这些患者手术评估和规划的辅助工具。虽然经阴道超声仍然是筛查的首选检查方法，但磁共振成像（MRI）已成为子宫内膜癌分期以及复发或治疗反应成像评估的首选方式。动态对比增强和扩散加权MRI相结合可提供最高的分期准确性。CT和MRI在评估淋巴结受累或远处转移方面表现相当。正电子发射断层显像（PET）-CT更适合评估高分级氟代脱氧葡萄糖（FDG）摄取性肿瘤中的淋巴结病变或治疗后临床怀疑的复发情况。本文综述了成像技术在子宫内膜癌诊断、分期、复发检测及治疗中的合理应用和指南。美国放射学会适宜性标准是针对特定临床情况的循证指南，由多学科专家小组每两年进行一次审查。指南的制定和审查包括对同行评审期刊上当前医学文献的广泛分析，以及应用成熟的共识方法（改良德尔菲法）由专家小组对成像和治疗程序的适宜性进行评分。在缺乏证据或证据不明确的情况下，可采用专家意见来推荐成像或治疗方法。
