ACR Appropriateness Criteria\Pretreatment Evaluation and Follow-Up of Endometrial Cancer
ACR Appropriateness Criteria\Pretreatment Evaluation and Follow-Up of Endometrial Cancer
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DOI：
10.1097/ruq.0000000000000068
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发表时间：
2014-03-01
影响因子：
1.3
通讯作者：
Zelop, Carolyn M.
中科院分区：
文献类型：
--
作者：
Lalwani, Neeraj;Dubinsky, Theodore;Zelop, Carolyn M.
子宫内膜癌是美国女性最常见的妇科疾病，也是第四大常见恶性肿瘤。横断面成像在子宫内膜癌的治疗前评估中起着至关重要的作用，应该被视为这些患者手术评估和计划的补充工具。虽然经阴道超声仍是筛查的首选检查方法，但MRI已成为子宫内膜癌分期和复发或治疗反应的影像评估的首选方法。动态增强和弥散加权MRI的结合为分期提供了最高的准确性。CT和MRI在评估结节受累或远处转移方面表现相同。PET-CT更适合于评估高级别FDG阳性肿瘤的淋巴结病变或临床怀疑治疗后复发。本文综述了影像技术在子宫内膜癌的诊断、分期、检测及复发性疾病治疗中的合理应用和指导原则。美国放射学会适当性标准((R))是针对特定临床情况的循证指南，由一个多学科专家小组每两年审查一次。指南的制定和审查包括对同行评议期刊中当前医学文献的广泛分析，以及应用公认的共识方法(修改后的德尔福)来评估专家小组成像和治疗程序的适当性。在缺乏证据或证据不明确的情况下，可以使用专家意见来建议进行成像或治疗。
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((R)) 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.