FIGO 2023 staging drops MRI‐pathology concordance in endometrial cancer to 76%

Major‐stage agreement between preoperative pelvic MRI and final pathology fell from 86.6% (FIGO 2009) to 76.2% (FIGO 2023), driven by missed minimal myometrial invasion and lymph‐node micrometastases. Molecular data alone reclassified 15% of patients, altering initial management…

• Retrospective dual‐center study of 231 women (median age 63 y); MRI rFIGO stage compared with pFIGO 2009 and 2023 from surgical specimens, including molecular status.
• Substage concordance declined from 74.0% (2009) to 56.3% (2023) (P<0.001); lymphovascular space invasion, histologic type, and micrometastatic nodes were leading causes of discord.
• Single most important limitation: retrospective design and reliance on molecular data that are not visible on MRI, limiting external validity of the observed concordance drop.

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