Early presentation of endometrial cancer permits effective management
with excellent clinical outcome. The addition of hysteroscopy to
dilatation and curettage (D&C) in the evaluation of postmenopausal
bleeding adds little to the detection of malignancy. Imaging studies such
as computed tomography, magnetic resonance imaging, and positronemission
tomography may be of use in determining the presence of
extrauterine disease in patients medically unfit for surgical staging.
However, these studies are not sufficiently sensitive to replace surgical
staging and have little role in routine preoperative evaluation. Clinical
staging alone is clearly inadequate, as 23% of preoperative clinical
stage I/II patients are upstaged with comprehensive surgical staging.
Preoperative tumor grade from D&C or office biopsy may be inaccurate
and lead to an underestimate of tumor progression if used to determine
which patients should be surgically staged. Clinical estimation
of depth of invasion, with or without frozen section, is inaccurate and
may lead to underestimation of disease status when surgical staging is
not performed. The practice of resecting only clinically suspicious nodes
should be discouraged as it is no substitute for comprehensive surgical
staging. Comprehensive surgical staging provides proper guidance for
postoperative adjuvant therapy, avoiding needless radiation in 85% of
clinical stage I/II patients. Finally, resection of occult metastasis with
surgical staging may improve survival.