Staging by imaging in gynecologic cancer and the role of ultrasound - an update of European joint consensus statements

Sep 21, 2026

In recent years, pelvic ultrasound has rapidly expanded as a diagnostic imaging tool for identifying and staging gynecological cancers. Prospective multicenter evidence shows high accuracy for pre-operative locoregional ultrasound staging, supporting its use alongside pelvic MRI in leading gynecologic oncology units. This consensus statement reviews the role of pre-operative ultrasound and other imaging modalities in gynecologic cancer, aligning with European Society guidance.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Introduction

Ultrasound biomarkers and precision diagnostics

Imaging approaches for detailed staging

Advantages and clinical applications

Training, agreement, and implementation considerations

Review ► Additional supplemental material is published online only. To view, please visit the journal online ([http://dx.doi.org/](http://dx.doi.org/)[ ](http://dx.doi.org/)[10.1136/ijgc-2023-004609](10.1136/ijgc-2023-004609)) . For numbered affiliations see end of article. Correspondence to Professor Daniela Fischerova, Gynecologic Oncology Center, Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic; [daniela.fischerova@vfn.cz](daniela.fischerova@vfn.cz) For ‘Presented at statement’see end of article. Received 5 December 2023 Accepted 5 January 2024 © IGCS and ESGO 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ. To cite: Fischerova D, Smet C, Scovazzi U, et al. Int J Gynecol Cancer 2024;34:363–378 . Staging by imaging in gynecologic cancer and the role of ultrasound: an update of European joint consensus statements Daniela Fischerova ,1 Carolina Smet ,2 Umberto Scovazzi ,3 Diana Natacha Sousa ,4 Kristina Hundarova ,5 Ingfrid Salvesen Haldorsen 6 ABSTRACT In recent years the role of diagnostic imaging by pelvic ultrasound in the diagnosis and staging of gynecological cancers has been growing exponentially. Evidence from recent prospective multicenter studies has demonstrated high accuracy for pre-operative locoregional ultrasound staging in gynecological cancers. Therefore, in many leading gynecologic oncology units, ultrasound is implemented next to pelvic MRI as the first-line imaging modality for gynecological cancer. The work herein is a consensus statement on the role of pre-operative imaging by ultrasound and other imaging modalities in gynecological cancer, following European Society guidelines. INTRODUCTION During the last decade, the use of ultrasound in the diagnosis and locoregional staging of gynecological malignancies has increased. Several ultrasound biomarkers are already established in clinical practice for detection of gynecologic cancer, prediction of the risk of disease or therapeutic outcome, prediction of oncological outcome, and evaluation of treatment response. An example of a diagnostic biomarker is the Ovarian-Adnexal Reporting and Data System (O-RADS) risk stratification and management system1 based on the International Ovarian Tumor Analysis Assessment of Different NEoplasias in the AdneXa (IOTA ADNEX) risk prediction model,2 or morphologic descriptors.3 A prognostic biomarker is the American Joint Committee on Cancer (AJCC) TNM (Tumor, Node, Metastasis) staging system,4 and an example of a response biomarker is the Response Evaluation in Solid Tumors (RECIST) criteria.5 Ultrasound provides both morphology-based (eg, tumor echogenicity and size) and functional biomarkers (eg, tumor perfusion based on power Doppler assessment or using contrast agents) .6 7 With emerging machinelearning approaches, the applicability of precision ultrasound diagnostics will potentially further expand.8 The introduction of the high-resolution endovaginal probe allows detailed depiction of the pelvic anatomy, comparable to that achieved by pelvic MRI.9–14 Transabdominal ultrasound using a convex array probe provides detailed views of the abdominal organs, visceral and retroperitoneal lymph nodes, and peritoneum, guiding the prediction of disease resectability.15–17 Lastly, the use of a linear probe allows direct, high-resolution visualization of superficial structures, such as the peripheral lymph nodes (Figure 1) .18 19 This has led to the implementation of ultrasound next to pelvic MRI as the firstline modality in the assessment of locoregional stage in gynecologic cancers, according to the European Society of Gynecological Oncology (ESGO) guidelines.9–14 Ultrasound has the advantages of having low cost with high availability, involving no radiation exposure and minimal discomfort to the patient.20 21 Furthermore, ultrasound is an ideal t

FAQs

Why has pelvic ultrasound become more prominent in gynecologic cancer diagnosis and staging?

Evidence from recent prospective multicenter studies shows high accuracy for pre-operative locoregional ultrasound staging, supporting wider clinical adoption alongside pelvic MRI.

What types of biomarkers does ultrasound provide for gynecologic cancers?

Ultrasound offers morphology-based biomarkers (such as tumor echogenicity and size) and functional biomarkers, including tumor perfusion assessed by power Doppler and contrast agents.

What factors may limit the widespread implementation of ultrasound in staging?

Concerns include insufficient training, which can lead to ultrasound-related misdiagnosis; inter-rater agreement varies between less and more experienced sonographers, so structured training and certification are highlighted as important.

Sep 21, 2026

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