The updated 2023 staging of endometrial cancer: tips for MRI interpretation.

PURPOSE: This study aims to highlight the major modifications introduced in the FIGO 2023 staging system for endometrial cancer (EC) and their implications for MRI interpretation.

METHODS

This pictorial essay was based on a retrospective review of 27 histologically confirmed cases of endometrial cancer (EC) imaged between 2009 and 2023 at our institution. Cases were selected to represent a broad spectrum of FIGO 2009 and FIGO 2023 stages, emphasizing features with updated staging implications. Inclusion criteria were availability of preoperative pelvic MRI and complete histopathological data, including molecular classification when available. Exclusion criteria included suboptimal image quality or incomplete clinical records. MRI assessments were performed by two radiologists with 25 years of experience in gynecological imaging, respectively. In illustrative examples where inter-reader differences arose, consensus was reached after joint review; however, no formal inter-reader agreement statistics (e.g., kappa values) were calculated, given the descriptive nature of the study.

RESULTS

The revised FIGO 2023 staging incorporates molecular subtypes, refines classification criteria, and improves the prognostic significance of MRI findings in EC staging.

CONCLUSION

The integration of histopathology, molecular markers, and MRI features enhances diagnostic accuracy and treatment planning.