A United Kingdom national survey of pre-operative imaging and lymph node staging practices in early-stage endometrioid endometrial carcinoma

Background: The molecular classification system for endometrial carcinoma has been recently introduced, offering a new framework for diagnosis and management. This study aims to evaluate variations in clinical practice concerning pre-operative imaging and determine whether the adoption of molecular classification has influenced surgical staging practices. Methods: A peer-reviewed online survey was distributed to members of the British Gynaecological Cancer Society (BGCS) using Microsoft Forms. The survey was conducted from 26 January 2024, to 02 August 2024. Data from the responses were analyzed using Microsoft Excel (Version 16.89.1, 2024). Results: The survey received 69 responses, representing 82% of cancer centres in the United Kingdom (UK). For grade 1 endometrial carcinomas, 68 out of 69 respondents (99%) reported performing pelvic imaging (ultrasound or magnetic resonance imaging (MRI)) for pre-operative staging, with 32 out of 69 (46%) performing pelvic imaging exclusively. Among cases of grade 2 carcinomas, 27 out of 69 respondents (39%) relied solely on pelvic imaging. For grade 3 endometrial carcinomas, 68 out of 69 respondents (99%) reported conducting chest, abdomen, and pelvis Computerised Tomography (CT) scans. Notable variations were observed in lymph node staging practices. The majority of centres do not perform lymph node excision for grade 1–2, stage 1A carcinomas. Sentinel lymph node biopsy is typically employed for grade 1–2, stage 1B or higher and for all grade 3 carcinomas. Conclusions: There is significant variability in the approaches to pre-operative imaging and lymph node staging for grade 1 and grade 2 endometrioid endometrial carcinomas across the UK. Enhancing adherence to guidelines could increase the use of pre-operative chest X-rays while reducing the frequency of CT scans, thereby minimising radiation exposure for patients with low-risk endometrial carcinomas. Expanding access to sentinel lymph node biopsies will have substantial implications for provision of services, particularly cancer units, in the UK.