The role of CT scans in endometrial cancer diagnosis: tumor spread and incidental findings

BACKGROUND: Swedish national guidelines recommend computed tomography (CT) of the thorax and abdomen at diagnosis of endometrial cancer (EC), whereas European guidelines suggest CT primarily for patients at risk of advanced disease. As metastatic disease is uncommon in EC and incidental findings are frequent, we evaluated the diagnostic yield of routine CT regarding treatment planning and the prevalence and clinical impact of incidental findings. METHODS: This retrospective study included 195 women with endometrial cancer who underwent CT scan at diagnosis. Women with symptoms of disseminated disease at diagnosis were excluded. Data were obtained from medical records. Descriptive statistics were applied to estimate the frequency of suspected metastatic according to histology and incidental findings and their impact on management. RESULTS: Suspected metastatic disease was identified in 11 patients (5.6%), leading to altered management in eight (4.1%), all with high-risk histology. Among 129 patients (66.2%) with low-grade endometrioid carcinoma, two (1.6%) had suspected metastases, none resulting in treatment changes. Of 57 patients (29%) with high-risk histology, nine (15.8%) had suspected metastases. Incidental findings occurred in 43 patients (22.1%), prompting 62 additional investigations. Pulmonary nodules were most common (10.7%). Two primary lung cancers were diagnosed. Twenty-five CT scans were required to alter management in one patient. CONCLUSION: Routine CT at EC diagnosis detects more incidental findings than metastatic disease. Clinical benefit appears confined to high-risk histologies, while its value in low-grade disease is limited.