Endometrial Cancer MRI Staging (FIGO 2023)

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] MRI invasion assessment
   MRI assessment of depth of myometrial invasion / cervical stroma / histology? (MRI (T2WI + DWI + DCE combined) assesses depth of myometrial invasion, cervical stromal invasion, nodes. Key: an intact low-signal junctional zone (JZ) on T2WI + a smooth continuous early subendometrial enhancement band on DCE = excludes myometrial invasion; disruption = invasion. Tumor is often isointense to myometrium, delineated on DWI. Pitfalls: fibroid/adenomyosis blurring the interface, postmenopausal JZ atrophy, cyclic cervical signal in the young.)
   • No myometrial invasion (intact JZ/subendometrial enhancement band) → No myometrial invasion · fertility preservation assessable
   • Myometrial invasion <50% (IA) → IA (<50%) · early surgery
   • Myometrial invasion ≥50% (IB)/cervical stromal invasion (IIA)/any invasion + aggressive histology (IIC) → IB/IIA/IIC · gynecologic oncology consult
   • Beyond the uterine corpus (vagina/parametrium/nodes/bladder-rectum/distant) → Advanced (beyond the uterine corpus)
2. [End] No myometrial invasion · fertility preservation assessable
   No myometrial invasion: FIGO 2023 requires explicit reporting of myometrial invasion; those without invasion are candidates for fertility-sparing treatment (must meet low-risk histology/grade, with rigorous monitoring), gynecologic oncology assessment.
3. [End] IA (<50%) · early surgery
   <50% myometrial invasion = IA: early, usually total hysterectomy + bilateral salpingo-oophorectomy ± staging surgery; MRI depth of invasion guides surgical extent and whether nodal assessment is needed.
4. [End] IB/IIA/IIC · gynecologic oncology consult
   ≥50% myometrial invasion (IB)/cervical stromal invasion (IIA)/any invasion + aggressive histology upstaging to IIC: deep invasion associates with LVSI/high grade/nodal metastasis; gynecologic oncology consult + complete nodal assessment (imaging/surgery), add adjuvant chemoradiation by risk stratification.
5. [End] Advanced (beyond the uterine corpus)
   Beyond the uterine corpus (vagina/parametrium, pelvic/para-aortic nodes, bladder-rectum, distant): advanced, MDT; complete PET-CT/nodal assessment, combined surgery ± chemoradiation ± hormonal/targeted therapy.

Source guidelines & references

• Endometrial cancer 2023 FIGO revised staging and imaging (PMC 2024)
• Endometrial cancer MRI assessment update (RadioGraphics 2022) · source ↗

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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