The 2026 update of the ACR Appropriateness Criteria for endometrial cancer covers imaging before treatment, during surveillance and when recurrence is suspected.
Pelvic MRI with and without contrast is rated usually appropriate for local staging across tumour types and grades. For aggressive histology or suspected spread, CT of chest, abdomen and pelvis and FDG-PET/CT are usually appropriate. Routine surveillance imaging is usually not appropriate for asymptomatic patients treated for low- or intermediate-risk disease, while CT may be appropriate in selected high-risk patients. For suspected recurrence, MRI, CT and PET/CT are all usually appropriate.
The practical change is in follow-up. Scheduled scans for asymptomatic women after low-risk disease add cost and anxiety without support from these criteria; imaging should be triggered by symptoms or high-risk features.
- Request pelvic MRI with contrast for local staging of endometrial cancer
- Add CT or PET/CT for aggressive histological types or suspected metastases
- Avoid routine surveillance scans in asymptomatic women after low- or intermediate-risk disease
- Image promptly when symptoms suggest recurrence
- Reserve scheduled CT surveillance for selected high-risk patients
Why it matters
Routine follow-up scans after low-risk endometrial cancer are common and, by these criteria, not appropriate.
Don't overread it
Appropriateness ratings partly rest on expert consensus where trial evidence is thin.
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