Article Data

  • Views 1009
  • Dowloads 151

Original Research

Open Access

Risk of nodal metastasis associated with lymphovascular space invasion in endometrial cancer

  • Burak Tatar1,*,

1Department of Gynecologic Oncology, Health Sciences University Samsun Research and Training Hospital, 55060 Samsun, Turkey

DOI: 10.31083/j.ejgo4205130 Vol.42,Issue 5,October 2021 pp.850-854

Submitted: 31 March 2021 Accepted: 17 May 2021

Published: 15 October 2021

*Corresponding Author(s): Burak Tatar E-mail: buraktatar@yahoo.com

Abstract

Objective: We conducted this study to investigate the risk of lympho-vascular space invasion (LVSI) on lymph node metastasis in endo-metrial cancer. Methods: Between August 2017 and December 2019, we enrolled 88 consecutive patients with a preoperative histologically confirmed diagnosis of clinical stage 1 endometrioid type endome-trial carcinoma, who had undergone hysterectomy and 59 of these patients required staging lymphadenectomy. We used Pearson's correlation coefficient and Mc Nemar's test for comparing LVSI and myometrial invasion to predict lymph node metastasis. Logistic regression analysis used for determining predictors for lymph node (LN) metastasis. Results: 75% of tumors with pelvic lymph node metas-tasis had LVSI, whereas 80% of the patients with pelvic lymph node negative tumors did not have LVSI and there was a significant cor-relation between LVSI and pelvic lymph node metastasis (p < 0.01). Sensitivity for LVSI in predicting pelvic lymph node involvement was 75%, specificity was 80.4%, positive predictive value (PPV) was 38%and negative predictive value (NPV) was 95.3% (p < 0.05) (95% confi-dence interval (CI) 1.3–82, hazard ratio (HR): 10.3). Sensitivity for LVSI to predict paraaortic lymph node involvement was 85.7%, speci-ficity 80.8%, PPV 38% and NPV 97.6% (p < 0.05) (95% CI 1.7–205 HR: 18.8). Pathological examination results with myometrial invasion more than half of the myometrium that has 75% sensitivity, 51%specificity, 19% PPV and 93% NPV for pelvic lymph node metastasis, thus, LVSI seems to have equal sensitivity but more specificity (p < 0.05). Discussion: This study demonstrates that LVSI is an independent predictor of LN metastasis for apparently Stage 1 endometrioid type endometrial carcinoma. If feasible, incorporating intraoperative frozen section analysis of LVSI may be used when deciding to perform lymphadenectomy. LVSI status is at least as important as myometrial invasion status of the tumor and LVSI may be a better indicator of lymph node metastasis.


Keywords

Endometrial cancer; Lymphovascular space invasion; Lymph node metastasis


Cite and Share

Burak Tatar. Risk of nodal metastasis associated with lymphovascular space invasion in endometrial cancer. European Journal of Gynaecological Oncology. 2021. 42(5);850-854.

References

[1] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018; 68: 394–424.

[2] Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer: a gynecologic oncology group study. Cancer. 1987; 60: 2035–2041.

[3] Tejerizo-García A, Jiménez-López JS, Muñoz-González JL, Bartolomé-Sotillos S, Marqueta-Marqués L, López-González G, et al. Overall survival and disease-free survival in endometrial cancer: prognostic factors in 276 patients. OncoTargets and Therapy. 2013; 9: 1305–1313.

[4] Milam MR, Java J, Walker JL, Metzinger DS, Parker LP, Coleman RL. Nodal Metastasis Risk in Endometrioid Endometrial Cancer. Obstetrics & Gynecology. 2012; 119: 286–292.

[5] Gal D, Recio FO, Zamurovic D, Tancer ML. Lymphvascular space involvement–a prognostic indicator in endometrial adenocarci-noma. Gynecologic Oncology. 1991; 42: 142–145.

[6] Cohn DE, Horowitz NS, Mutch DG, Kim S, Manolitsas T, Fowler JM. Should the Presence of Lymphvascular Space Involvement be used to Assign Patients to Adjuvant Therapy Following Hysterectomy for Unstaged Endometrial Cancer? Gynecologic Oncology. 2002; 87: 243–246.

[7] Briët JM, Hollema H, Reesink N, Aalders JG, Mourits MJE, ten Hoor KA, et al. Lymphvascular space involvement: an independent prognostic factor in endometrial cancer. Gynecologic Oncology. 2005; 96: 799–804.

[8] Karabük E, Düzgüner INB; Ilgin H, Duzguner S, Tulunay G. The Relationship between Lymphovascular Space Invasion and Lymph Node Metastasis in Endometrial Cancer. Journal of Turkish Society of Obstetrics & Gynecology. 2014; 11: 29–34.

[9] Vaizoglu F, Yuce K, Salman MC, Basaran D, Calis P, Ozgul N, et al. Lymphovascular space involvement is the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer. Archives of Gynecology and Obstetrics. 2013; 288: 1391–1397.

[10] Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecologic Oncology. 2004; 92: 744–751.

[11] Frost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane database of systematic reviews. 2017; 10: CD007585.

[12] Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Sig-norelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. Journal of the National Cancer Institute. 2008; 100: 1707–1716.

[13] Kitchener HC. The effect of incision in the surgical treatment of endometrial cancer and long-term follow-up of a randomized trial of lymphadenectomy: Results of the MRC ASTEC trial. Journal of Clinical Oncology. 2011; 29: e15583–e15583.

[14] Bogani G, Dowdy SC, Cliby WA, Ghezzi F, Rossetti D, Mariani A. Role of pelvic and para-aortic lymphadenectomy in endome-trial cancer: current evidence. The Journal of Obstetrics and Gynaecology Research. 2014; 40: 301–311.

[15] Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? American Journal of Obstetrics and Gynecology. 2000; 182: 1506–1519.

[16] Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. International Journal of Gynecological Cancer. 2016; 26: 2–30.

[17] Zhu M, Jia N, Huang F, Liu X, Zhao Y, Tao X, et al. Whether intermediate-risk stage 1a, grade 1/2, endometrioid endometrial cancer patients with lesions larger than 2 cm warrant lymph node dissection? BMC Cancer. 2017; 17: 696.

[18] Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. The Lancet. 2010; 375: 1165–1172.

[19] Kitchener H, Swart AMC, Qian Q, Amos C, Parmar MKB. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. The Lancet. 2009; 373: 125–136.

[20] Hanson MB, van Nagell JR, Powell DE, Donaldson ES, Gallion H, Merhige M, et al. The prognostic significance of lymphvascular space invasion in stage I endometrial cancer. Cancer. 1985; 55: 1753–1757.

[21] Jorge S, Hou JY, Tergas AI, Burke WM, Huang Y, Hu JC, et al. Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer. Gynecologic Oncology. 2016; 140: 387–393.

[22] Weinberg LE, Kunos CA, Zanotti KM. Lymphovascular Space Invasion (LVSI) is an Isolated Poor Prognostic Factor for Recurrence and Survival among Women with Intermediate- to High-Risk Early-Stage Endometrioid Endometrial Cancer. Inter-national Journal of Gynecological Cancer. 2013; 23: 1438–1445.

[23] Bosse T, Peters EEM, Creutzberg CL, Jürgenliemk-Schulz IM, Jobsen JJ, Mens JWM, et al. Substantial lymphvascular space invasion (LVSI) is a significant risk factor for recurrence in endome-trial cancer—a pooled analysis of PORTEC 1 and 2 trials. European Journal of Cancer. 2015; 51: 1742–1750.

[24] Ballester M, Bendifallah S, Daraï E. European guidelines (ESMO-ESGO-ESTRO consensus conference) for the management of endometrial cancer. Bull Cancer. 2017; 12:1032–1038.

[25] Togami S, Kubo R, Kawamura T, Yanazume S, Kamio M, Kobayashi H. Risk factors for lymphatic complications following lymphadenectomy in patients with endometrial cancer. Tai-wanese Journal of Obstetrics and Gynecology. 2020; 59: 420–424.

[26] Hareyama H, Hada K, Goto K, Watanabe S, Hakoyama M, Oku K, et al. Prevalence, Classification, and Risk Factors for Postoperative Lower Extremity Lymphedema in Women with Gynecologic Malignancies: a Retrospective Study. International Journal of Gy-necologic Cancer. 2015; 25: 751–757.

[27] Scribner DR, Walker JL, Johnson GA, McMeekin DS, Gold MA, Mannel RS. Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecologic Oncology. 2002; 84: 426–430.

[28] AlHilli MM, Podratz KC, Dowdy SC, Bakkum-Gamez JN, Weaver AL, McGree ME, et al. Preoperative biopsy and intraoperative tumor diameter predict lymph node dissemination in endometrial cancer. Gynecologic Oncology. 2013; 128: 294–299.

[29] Capozzi VA, Sozzi G, Uccella S, Ceni V, Cianciolo A, Gambino G, et al. Novel preoperative predictive score to evaluate lymphovascular space involvement in endometrial cancer: an aid to the sentinel lymph node algorithm. International Journal of Gynecologic Cancer. 2020; 30: 806–812.

[30] Kumar S, Bandyopadhyay S, Semaan A, Shah JP, Mahdi H, Morris R, et al. The role of frozen section in surgical staging of low risk endometrial cancer. Public Library of Science, 2011; 6: e21912.

[31] Peters EEM, Bartosch C, McCluggage WG, Genestie C, Lax SF, Nout R, et al. Reproducibility of lymphovascular space invasion (LVSI) assessment in endometrial cancer. Histopathology. 2019; 75: 128–136.

[32] Karabagli P, Ugras S, Yilmaz BS, Celik C. The evaluation of reliability and contribution of frozen section pathology to staging endometrioid adenocarcinomas. Archives of Gynecology and Obstetrics. 2015; 292: 391–397.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time

Conferences

Top