Positive cytology should be reported separately without changing the stage.

**Table 1.** Surgical staging of endometrial carcinoma


\*Examinations to be requested according to symptoms and clinical signs

**Table 2.** Examinations to be done for staging of endometrial carcinoma

A meta-analysis did not find significant differences in comparing the diagnostic accuracy of ultrasound, CT, and MRI in the staging of endometrial carcinoma, noting that the use of contrast during MRI significantly improves the performance of the method. The advantage of MRI is that it can demonstrate myometrial invasion and later stages of the disease, such as extra-uterine disease. MRI and PET/CT in patients with endometrial carcinoma were similar in the diagnosis of the primary lesion (sensitivity of 91.5 vs. 89.4%, specificity of 33.3% vs. 50.5%, accuracy of 84.9 vs. 84.9%, PPV of 91.5 vs. 93.3%, and VPN of 33.3 vs. 37.5%) and also for the detection of lymph node metastasis. The main benefit of F18-FDG PET/CT is the detection, localization, and characterization of distant metastases, including extraperitoneal metastases, and in the follow-up of recurrence. Due to the high negative predictive value in detecting lymph node metastases, it may be useful in patients with surgical contraindication. Its low positive predictive value can be related to the difficulty in differentiating reactive lymph nodes after endometrial biopsy, so PET/CT cannot replace surgical staging. While PET only demonstrates the existence of the lesion, PET/CT adds anatomic location to study. Endometrial carcinoma, similar to other tumors, has a high rate of glycolysis and uptake of FDG, a radio‐ active glucose analogue. There is a need for prospective studies comparing the methods, including cost-benefit assessment, so as to define the true benefits of these procedures.[7, 12, 13]

It should not be routinely used in the staging and follow-up considering the need for additional studies of the method and its high cost. Consider the use in cases of surgical and high contra‐ indication risk of distant metastases, evaluating value for money.

#### **4. Factors associated with prognosis**

**Stage Postoperative pathological findings** I\* Tumor confined to uterine corpus

III\* Tumor local and/or regionally spreading IIIA\* Tumor invading serosa and/or adnexa# IIIB\* Tumor invading vagina and/or parametrium#

Positive pelvic lymph nodes

IVA\* Tumor invading bladder and/or rectal mucosa

FIGO Staging – 1988, revised in 2009 [9, 10]

**Table 1.** Surgical staging of endometrial carcinoma

Radiological examinations Chest X-ray Specific examinations Endometrial biopsy

Other examinations that are not considered for staging but can be done for treatment

IIIC\* IIIC1\* IIIC2\*

\* G1, G2 or G3.

planning

IA\* No invasion or myometrial invasion less than 50% IB\* Myometrial invasion less than or equal to 50%

316 Gynecologic Cancers - Basic Sciences, Clinical and Therapeutic Perspectives

II\* Tumor invading cervical stroma, but without extending beyond uterus\*\*

Metastasis to pelvic and/or para-aortic lymph nodes #

IV\* Tumor invading bladder and/or rectal mucosa and/or distant metastases

Positive para-aortic lymph nodes with or without positive pelvic lymph nodes

Examination of lymphatic drainage with palpation of supraclavicular and

Rectovaginal examination with or without analgesia

Hysteroscopy with biopsy or curettage

IVB\* Distant metastases, including intra-abdominal and/or inguinal lymph node metastases

inguinal lymph nodes Gynecological examination

Cystoscopy\* Rectosigmoidoscopy\*

Ultrasound

Computed tomography Magnetic resonance

Bone scintigraphy Laparoscopy Serum CA-125

Positron emission tomography

\*\* Only endocervical gland involvement should be considered as stage I and no longer as stage II.
