Abstract
IntroductionEndometrial carcinoma is associated with several known prognostic factors. Recently, lymphovascular invasion (LVI) has gained a prominent position in the risk assessment of early endometrioid endometrial carcinoma, in identifying patients who can benefit from adjuvant radiation therapy. This study aims to assess LVI in early-stage endometrioid endometrial carcinoma accurately with emphasis on its extent /grading. We also propose a few local recommendations for improving LVI reproducibility in endometrial carcinoma to guide future studies.MethodsThe duration of this retrospective study was 2 years. Early-stage I (Ia and Ib), and grade 1 and 2 endometrioid endometrial carcinomas were included. 03 reviewers independently recorded their findings on H&E stained slides. LVI was graded as none, focal and substantial. In discordant cases, immunohistochemical stain CD 31 was used.All the data was entered in the statistical software SPSS version 26 and analyzed for frequencies. The relationships between various histological parameters assessed and the degree of reproducibility for LVI amongst various observers were also determined.ResultsOut of a total of 70 cases of endometrioid carcinoma diagnosed on hysterectomy specimen, only 32 met our inclusion criteria. The rate of LVI positivity was 6.3 %, 34.4 %, and 37.5 % respectively for reviewers 1, 2, and 3. The degree of reproducibility in LVI assessment and LVI grading was significant amongst reviewers 2 and 3. Also, a significant association was drawn between tumor grade and LVI.ConclusionDespite limitations in our study we recommend including both LVI assessment and grading in routine reporting formats locally. By adding a second reviewer in LVI assessment and using CD31 in discrepant cases LVI positivity can be significantly increased.
Highlights
Endometrial carcinoma is associated with several known prognostic factors
Out of a total of 70 cases of endometrioid carcinoma diagnosed on hysterectomy specimen, only 32 met our inclusion criteria
The degree of reproducibility in lymphovascular invasion (LVI) assessment and LVI grading was significant amongst reviewers 2 and 3
Summary
Lymphovascular invasion (LVI) has gained a prominent position in the risk assessment of early endometrioid endometrial carcinoma, in identifying patients who can benefit from adjuvant radiation therapy. This study aims to assess LVI in early-stage endometrioid endometrial carcinoma accurately with emphasis on its extent /grading. Lymphovascular invasion (LVI), defined as the presence of tumor cells within endothelial-lined spaces within the uterine wall outside the main tumor, is an independent poor prognostic factor in early-stage. The ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer in 2016 recommended adjuvant radiation treatment for patients with grade 1 or 2, stage I Endometrioid endometrial cancer (EEC) in the presence of unequivocal LVI, independent of the depth of myometrial invasion (Colombo et al 2016) The International Federation of Obstetrics and Gynecology (FIGO) Cancer Report published in 2018 on Cancer of the Corpus Uteri, identified four histological parameters including tumor grade 3 (poorly differentiated), lymphovascular space invasion, non-endometrioid histology, and cervical stromal involvement as predictors of poor prognosis (Amant 2018).
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