ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer: 2026 Update

Endometrial cancer is the most common gynecologic malignancy in the United States, and accurate pretreatment evaluation is essential for risk stratification, treatment planning, and detection of recurrent disease. This evidence-based review summarizes imaging recommendations for patients with established endometrial cancer undergoing pretreatment assessment, surveillance, or evaluation for suspected recurrence. MRI pelvis without and with intravenous contrast is usually appropriate for assessment of local tumor extension across histologic subtypes and grades. For aggressive histologic tumor types, or when metastatic disease is suspected, CT chest, abdomen, and pelvis with intravenous contrast and FDG-PET/CT are usually appropriate for evaluation of nodal and distant metastases. Routine imaging surveillance is usually not appropriate for asymptomatic patients with treated low- or intermediate-risk disease, whereas CT may be appropriate in selected asymptomatic high-risk patients. MRI pelvis, CT chest, abdomen, and pelvis, and FDG-PET/CT are usually appropriate for suspected recurrence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.