Objective:
Local surgical pathological factors that determine lymphovascular space invasion (LVSI) and LVSI impact on lymph node spread of tumor were investigated in Endometrial Cancer(EC).
Material and Method:
A total of 355 patients,systematic lymphadenectomy staging surgery performed between January 1993 and December 2012,diagnosed with stage 1A-IVB EC were included.Pathological data was obtained from the final pathology report.Staging was made according to FIGO 2009 criteria.Patients who had diagnosis of uterine sarcoma, tumors with component of sarcoma and patients with two primary tumors were excluded.LVSI was described as tumor cells or cell clusters that attached to vessel wall on hematoxylin and eosin(H&E)stain.
Results:
The average age of patients was 59 years and tumor size was 43.4mm.279 patients had tumor with endometrioid type and 120 of them had grade 3 tumor.LVSI was detected in 147(41.4%) patients.20 of patients didn’t have myometrial invasion while the tumor spread through serosa was detected on 11 patients.Cervical invasion was detected in 78 patients and there was also stromal invasion in 68 of them.Tumor spread out lymph nodes in 77 (21.7%) patients.Lymphatic invasion was at para-aortic region in 49 (13.8%) patients and in pelvic region in 64 patients (18%).Grade, depth of myometrial invasion,involvement of uterine serosa,cervical invasion and tumor size increased the existence of LVSI.However tumor type and age had no relation with LVSI.LVSI has been defining the tumor spread to lymph nodes.Lymph node metastasis was found in 38.8% of the patients who had LVSI compared to 9.6% of those without LVSI.When both regions (para-aortic and pelvic) were evaluated separately,LVSI was significant in terms of tumor metastasis.
Conclusion:
LVSI was observed in 40% of patients who were staged with diagnosis of EC and the spread of lymph node was present in 40% of these patients.It is clear that this parameter will play an important role in determining adjuvant therapy and surgery type.
Keywords: Endometrial cancer, Lymphovascular space invasion, Lymph node metastasis