Lymphovascular Space Invasion as a Risk Factor in Early Endometrial Cancer

Abstract

Management of early endometrial cancer is contentious these days with little agreement between oncologists as well as across MDTs or tumour boards and indeed across countries. This is because of the state of knowledge with regards to risk factors in early endometrial cancer; although we recognise risk factors affect outcome, we haven't yet been able to demonstrate that our treatments make a significant difference. We have reviewed available literature on LVSI and are able to demonstrate that it is an independent risk factor for nodal metastasis as well as distant recurrence. We need a randomised trial integrating grade and LVSI and testing therapeutic options of radiotherapy and chemotherapy. However, it is unlikely to see the light of day. Therefore, we are left with this knowledge of prognostic factors and it is our duty to integrate this into our decision-making during our multidisciplinary team meetings and make decisions tailored to individual patient circumstances.

Identifiable Risk Factors for Lymph Node Metastases in Grade 1 Endometrial Carcinoma

“…32 Taking under consideration the growing incidence of laparoscopic total hysterectomies using an intrauterine balloon manipulator, pathologists should be very aware of the existence of artifactual vascular pseudoinvasion that should be suspected to avoid unnecessary adjuvant treatment. 33 …”

Preoperative Magnetic Resonance Volumetry in Predicting Myometrial Invasion, Lymphovascular Space Invasion, and Tumor Grade: Is It Valuable in International Federation of Gynecology and Obstetrics Stage I Endometrial Cancer?

“…However, the information of LVSI, which is an independent risk factor for nodal metastasis and distant recurrence, is available only after hysterectomy. 4 Tumor size has been reported to have a prognostic impact in endometrial cancer since 1960s. 5 Although International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer does not include tumor size measurement, relationship of large macroscopic tumor size in hysterectomy specimen and poor survival has long been known.…”

Risk Factors for Lymph Node Metastasis among Lymphovascular Space Invasion-Positive Women with Endometrioid Endometrial Cancer Clinically Confined to the Uterus

“…In our study, the corresponding figure was 45.5%, in agreement with previous reports. Although positive LVSI is not taken into account in the current FIGO staging classification [3], its presence forces a staging lymphadenectomy to assess LN involvement or the need of adjuvant treatment in an incomplete surgery [14], but neither of these is exempt from morbidity [25]. Unfortunately, LVSI status is usually not available until after hysterectomy, at the time of preparation of the final pathology report.…”

“…This information can only be integrated into the decision-making process once a hysterectomy has been performed [5]. Some authors argue that the presence of LVSI on a uterine specimen is sufficient for a staging lymphadenectomy to assess LN involvement [2,4,8,13,14]. Nevertheless, it is not clear how many patients with positive LVSI have increased risk for LN involvement, or if LVSI alone is enough for decision-making [15].…”