Endometrial carcinoma

(1) Regarding the endometrial carcinoma,

1. In Europe, endometrial carcinoma is second most common gynaecological malignancy, following cervical carcinoma.
2. In the UK, most of the endometrial carcinomas present late
3. FIGO Staging is based on MRI the of the pelvis and CT scan of the abdomen.
4. Endometrial carcinoma accounts for approximately 10% of postmenopausal bleeding
5. The incidence of nodal metastasis is 3% with deep myometrial invasion (stage IC).

Answers: F, F, F, T, F
(2) Regarding endometrial carcinoma,

1. CT is more accurate than endovaginal ultrasound in the diagnosis of myometrial invasion.
2. Zonal uterine anatomy is best seen on the T1WI.
3. Endometrial carcinoma is typically of low signal on the T2WI.
4. Endometrial carcinoma is of high signal compared to cervical stroma on the T2WI.
5. Lung is the most common site of distant metastasis

Answers: F, F, T, T, T
Notes:
Endometrial carcinoma is the most common gynaecological malignancy, followed by cervical carcinoma. Most of them present early, 75-80% in stage I, and have a good prognosis. Endometrial carcinoma accounts for 7-14% of post menopausal bleeding. FIGO staging is surgical and pathological based as clinical staging is inaccurate. FIGO does not consider imaging in the staging. However, the role of MRI in the diagnosis of myometrial and cervical invasion is increasing recognised. The incidence of nodal involvement is 3% with stage IB and 40% with stage IC and MRI may play an important role in this. Lymphadenectomy is done for Grade I/II with more than 50% myometrial invasion and for all grade III disease. A large randomised ASTEC (A Study in the Treatment of Endometrial Cancer) is being carried out to address role of lymhadenectomy and post-operative radiotherapy.
Overall accuracy of MRI is 83-92% and endovaginal ultrasound (77%) is more accurate than CT(61-76%) in predicting the myometrial invasion. Zonal anatomy is best seen on the T2WI and endometrial carcinoma is typically of low signal on the T2WI and enhance more slowly than myometirum on the dynamic enhancement scan. Inner myometrium is brighter than outer myometrium on dynamic MRI and maximum contrast between the two occurs at 50s. Endometrial carcinoma is of high signal compared to cervical stroma on T2WI.
Reference: Barwick TD et al. Imaging of endometrial carcinoma. Clin Rad (2006) 61, 545-555