Updated ESUR Guidelines for Endometrial Cancer: integrating MRI with the 2023 FIGO Staging Revolution

Stephanie Nougaret^{1

2}, Evis Sala^{3

4}, Yulia Lakhman⁵, Elisabeth Sadowski⁶, Aradhana M Venkatesan⁷, Andrea Rockall^{8

9}, Isabelle Thomassin-Naggara¹⁰, Aki Kido¹¹, Nishat Bharwani^{12

13}, Teresa Margarida Cunha¹⁴, Rosemarie Forstner¹⁵, Pamela Causa-Andrieu¹⁶, Giacomo Avesani³, Ingfrid Haldorsen¹⁷, Alejandra Martinez^{18

19}, Lucia Manganaro^#²⁰, Stefania Rizzo^#^{21

22}

Affiliations

¹ Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090, Montpellier, France. stephanienougaret@free.fr.
² PINKCC Laboratory, INSERM U1194, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France. stephanienougaret@free.fr.
³ Dipartimento Diagnostica per Immagini e Radioterapia Oncologica, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁴ Dipartimento di Scienze Radiologiche ed Ematologiche, Universita Cattolica del Sacro Cuore, Roma, Italy.
⁵ Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁶ Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁷ Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
⁹ Dept of Radiology, Imperial College, Healthcare NHS Trust, London, UK.
¹⁰ Radiology Imaging and Interventional Radiology Specialized Department (IRIS), Tenon Hospital, Public Hospital of Paris, Paris, France.
¹¹ Radiology department, Toyama University, Toyoma, Japan.
¹² Department of Imaging, Imperial College Healthcare NHS Trust, London, UK.
¹³ Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁴ Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
¹⁵ Department of Radiology, University Hospital of Salzburg, PMU, Salzburg, Austria.
¹⁶ Department of Radiology, Mayo Clinic, Rochester, MN, USA.
¹⁷ Department of Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
¹⁸ Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France.
¹⁹ Université Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, INSERM, Toulouse, France.
²⁰ Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
²¹ Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), via Tesserete 46, 6900, Lugano, Switzerland.
²² Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), via G. Buffi 13, 6900, Lugano, Switzerland.

^# Contributed equally.

PMID: 40586816
DOI: 10.1007/s00330-025-11700-3

Updated ESUR Guidelines for Endometrial Cancer: integrating MRI with the 2023 FIGO Staging Revolution

Stephanie Nougaret et al. Eur Radiol. 2025.

. 2025 Jun 30.

doi: 10.1007/s00330-025-11700-3. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology, Montpellier Cancer Institute, University of Montpellier, 208 av des Apothicaires, 34090, Montpellier, France. stephanienougaret@free.fr.
² PINKCC Laboratory, INSERM U1194, Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France. stephanienougaret@free.fr.
³ Dipartimento Diagnostica per Immagini e Radioterapia Oncologica, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁴ Dipartimento di Scienze Radiologiche ed Ematologiche, Universita Cattolica del Sacro Cuore, Roma, Italy.
⁵ Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁶ Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁷ Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
⁹ Dept of Radiology, Imperial College, Healthcare NHS Trust, London, UK.
¹⁰ Radiology Imaging and Interventional Radiology Specialized Department (IRIS), Tenon Hospital, Public Hospital of Paris, Paris, France.
¹¹ Radiology department, Toyama University, Toyoma, Japan.
¹² Department of Imaging, Imperial College Healthcare NHS Trust, London, UK.
¹³ Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁴ Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
¹⁵ Department of Radiology, University Hospital of Salzburg, PMU, Salzburg, Austria.
¹⁶ Department of Radiology, Mayo Clinic, Rochester, MN, USA.
¹⁷ Department of Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
¹⁸ Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius Regaud, Toulouse, France.
¹⁹ Université Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, INSERM, Toulouse, France.
²⁰ Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
²¹ Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), via Tesserete 46, 6900, Lugano, Switzerland.
²² Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), via G. Buffi 13, 6900, Lugano, Switzerland.

^# Contributed equally.

PMID: 40586816
DOI: 10.1007/s00330-025-11700-3

Abstract

Objectives: To summarize the key updates introduced in the 2023 International Federation of Gynecology and Obstetrics (FIGO) classification for endometrial cancer (EC), and to highlight the role of MRI in aligning with these changes for improved staging and patient management.

Materials and methods: A review of the updated 2023 FIGO classification, which integrates molecular profiling and histopathological criteria, was conducted. Additionally, the revised European Society of Urogenital Radiology (ESUR) MRI recommendations were analyzed to assess their alignment with the new FIGO framework, focusing on their role in evaluating myometrial invasion (MI) and cervical stromal involvement.

Results: The updated FIGO classification incorporates molecular data to refine risk stratification and staging accuracy. MRI continues to play a pivotal role in distinguishing between stages, mapping disease extent, and guiding surgical planning. The updated ESUR recommendations emphasize standardized MRI protocols, particularly the use of multiphase contrast-enhanced imaging, to improve diagnostic confidence in assessing MI.

Conclusion: The integration of molecular classification into FIGO staging, supported by standardized and advanced MRI protocols as recommended by ESUR, enhances the management of endometrial cancer.

Key points: Question The 2023 FIGO update integrates molecular profiling into endometrial cancer staging, requiring MRI adaptations to improve accuracy in assessing disease extent, including myometrial invasion. Findings Updated ESUR MRI guidelines emphasize multiphase contrast-enhanced imaging, structured reporting, and integration with FIGO 2023 classification, enhancing diagnostic precision for staging and treatment planning. Clinical relevance Standardized MRI protocols aligned with FIGO 2023 system improve endometrial cancer staging, guiding optimal surgical and therapeutic strategies, reducing diagnostic variability, and enhancing patient outcomes through individualized risk stratification and personalized treatment.

Keywords: Diagnostic molecular pathology; Endometrial cancer; Gynecologic neoplasm; Magnetic resonance imaging; Practice guidelines.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Stephanie Nougaret. Conflict of interest: E. Sala has conflict of interest: co-founder and shareholder, Lucida Medical; Research support, GEHC, AWS; Speakers bureau, GEHC, BRACCO, Philips, AWS. The rest of the authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Yulia Lakhman consults for Perceptive Imaging and is supported in part by the National Institutes of Health/National Cancer Institute Cancer Center Support Grant (P30 CA008748). Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: The study does not include human subjects or animals. Ethical approval: Institutional Review Board approval was not required because it follows the guidelines. Study subjects or cohorts overlap: None Methodology: Recommendation guidelines.

References

1. Maheshwari E, Nougaret S, Stein EB et al (2022) Update on MRI in evaluation and treatment of endometrial cancer. Radiographics 42:2112–2130 - DOI - PubMed
1. Nougaret S, Horta M, Sala E et al (2019) Endometrial cancer MRI staging: updated guidelines of the European Society of Urogenital Radiology. Eur Radiol 29:792–805 - DOI - PubMed
1. Nougaret S, Lakhman Y, Vargas HA et al (2017) From staging to prognostication: achievements and challenges of MR imaging in the assessment of endometrial cancer. Magn Reson Imaging Clin N Am 25:611–633 - DOI - PubMed
1. Sbarra M, Lupinelli M, Brook OR, Venkatesan AM, Nougaret S (2023) Imaging of endometrial cancer. Radiol Clin North Am 61:609–625 - DOI - PubMed
1. Himoto Y, Lakhman Y, Fujii S et al (2021) Multiparametric magnetic resonance imaging facilitates the selection of patients prior to fertility-sparing management of endometrial cancer. Abdom Radiol (NY) 46:4410–4419 - DOI - PubMed

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Updated ESUR Guidelines for Endometrial Cancer: integrating MRI with the 2023 FIGO Staging Revolution

Affiliations

Updated ESUR Guidelines for Endometrial Cancer: integrating MRI with the 2023 FIGO Staging Revolution

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources