A Systematic Comparative Literature Review of Biomarkers, Imaging, and Therapeutic Strategies for Endometrial Cancer: Toward an Estrogen Receptor-Guided Near-Infrared Fluorescence Imaging and Endocrine Therapy Pipeline

Endometrial cancer (EC) is the most common gynecologic malignancy in high-income countries, with incidence rising alongside increasing obesity and population aging. Diagnosis still depends on invasive tissue biopsy and histopathology, a pathway that is costly, time-consuming, and burdensome for patients. As precision medicine increasingly emphasizes biomarker-guided, minimally invasive strategies, this study systematically compares candidate biomarkers, imaging modalities, and therapeutic strategies to identify the most clinically suitable combination for a minimally invasive diagnostic-therapeutic pipeline for EC. A systematic comparative literature analysis was conducted using PubMed, Google Scholar, Web of Science, ClinicalTrials.gov, and FDA resources, restricted to English-language publications from 2013–2026. Evidence on prevalence, diagnostic accuracy, safety, cost, and therapeutic relevance was organized into weighted decision matrices and a Multi-Criteria Decision Analysis. Among five candidate biomarkers, the estrogen receptor (ER) scored highest, reflecting its high prevalence in Type I endometrioid tumors, established assay infrastructure, and direct actionability with endocrine therapy. Among four imaging modalities, near-infrared (NIR) fluorescence endoscopy scored highest based on real-time signal acquisition and compatibility with existing endoscopic infrastructure. Endocrine therapy showed the strongest compatibility with ER-positive disease. Integrating these findings produced a proposed same-day pipeline, ER-targeted NIR fluorescence detection followed by endocrine therapy initiation, with an estimated reduction in time-to-treatment from 10–15 days to under 48 hours. This pipeline offers a scientifically coherent alternative to the conventional biopsy-dependent pathway for Type I, hormone-receptor-positive disease. However, this synthesis is based entirely on published literature; prospective validation, including probe development, imaging accuracy studies, and clinical trials, is required before real-world implementation.