Lymphovascular space involvement is the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer

Abstract

Lymphovascular space involvement is the sole predictor of lymph node metastasis in EC. Therefore, LVSI status should be requested from the pathologist during frozen examination whenever possible to consider when a decision to perform or omit lymphadenectomy is made.

Lymphovascular Space Invasion for Endometrial Cancer: Undertreatment and Overtreatment Risks

“…22 Pelvic LNM and LVSI are independent predictors of para-aortic LNM. 32,33 Lymphovascular space invasion was the only significant predictor of isolated para-aortic LNM in 75% of patients (P = 0.043) 24 and an independent risk factor for total (odds ratio, 2.6) and distant (odds ratio, 3.3) recurrences. Lymphovascular space invasion has a 96.4% of negative predictive value and a 97.1% positive predictive value for LNM, 26 so omitting lymphadenectomy could be safely made if LVSI is negative.…”

“…They can help to determine which patients may be at risk for occult LNM and therefore benefit from lymphadenectomy or adjuvant therapy. 14,23,24 Lymphovascular space invasion is defined as the presence of tumor cells inside the capillary lumens of either the lymphatic or microvascular drainage systems within the primary tumor. 25 Most respondents in our survey know about it.…”

“…31 There is low incidence of positive LVSI in early invasive stage, well-differentiated histology, and tumors measuring less than 2 cm, 24 whereas deep myometrial invasion (MI) and poorly differentiated tumors are statistically significantly associated with LVSI. 21,24,31 In Jorge et al 25 study, the estimated risk of nodal metastases was 21% in positive LVSI, compared with 2.1% (P G 0.0001) in negative LVSI. In Post-Operative Radiation Therapy in Endometrial Cancer 1 trial, LVSI was found in 5% of total patients and in 17% of patients with deep MI or grade 3 tumors.…”

Predicting Lympho-Vascular Space Invasion in Endometrial Cancers with Mucinous Carcinomatous Components

“…Ayeni et al (2013) also defined positive LVSI as a significant adverse prognostic factor. Vaizoglu et al (2013) found LVSI as the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer and offered routine evaluation of LVSI during frozen section analysis to decide on lymphadenectomy.…”

“…There is also a direct correlation with poor survival outcomes and nodal metastasis. Thus identifying predictors of LVSI may also help gynecological oncologists during surgery for deciding lymphadenectomy (Vaizoglu et al, 2013). Creasman et al (1987) reported an increased overall incidence of lymph node metastasis in clinically uterine restricted disease for grade 2 and 3 tumors.…”