The use of imaging in endometrial cancer prior to potential surgery: Are guidelines being followed?

Objectives. Clinical practice guidelines recommend against routine preoperative axial imaging studies (CT/ MRI) for endometrial cancer, except for cases of locally advanced disease or aggressive histologies. This study uti-lized population-based data to evaluate the use of preoperative imaging and factors associated with its use. Methods. A population-based cohort of women diagnosed with endometrial cancer from 2006 to 2016 were identified from the Ontario Cancer Registry in Ontario, Canada. Patients were excluded if they had: hysterectomy prior to the date of diagnosis, non-epithelial histology or a prior cancer diagnosis within 5 years. Preoperative im-aging (CT or MRI) rates were calculated over time. Predictive factors for preoperative imaging use were deter-mined using multi-variable regression analysis. Results. 17,718 cases were eligible for analysis. From 2006 to 2016, the proportion of patients receiving pre-operative imaging increased from 22.2% to 39.3%. In a subgroup of patients with low-risk disease (stage 1, endometrioid adenocarcinoma), imaging increased from 16.3% to 29.5%. Multivariate analysis showed an associ-ation between preoperative imaging and advanced stage, advanced grade, non-endometrioid morphology, sur-gery with a gynecologic oncologist, surgery at a teaching hospital and a later year of diagnosis. From 2006 to 2016, the yearly incidence of endometrial cancer increased from 22.3/100,000 to 36.1/100,000, representing a mean annual increase of 3.6% per year. Conclusions. Endometrial cancer incidence and the use of preoperative imaging are increasing. Factors most associated with preoperative imaging are high-risk features. However, preoperative imaging is still being per -formed in low-risk patients, indicating non-adherence to guidelines, which has implications for constrained healthcare resources. Crown Copyright (c) 2021 Published by Elsevier Inc. All rights reserved.

Automated summary

The incidence of endometrial cancer and the use of preoperative imaging are increasing annually in Ontario. Preoperative imaging is mainly associated with high-risk features, but it is still being performed in low-risk patients, indicating non-adherence to guidelines.