Evaluation of Lymphovascular Invasion in Endometrial Adenocarcinomas: Laparoscopic Versus Abdominal Hysterectomies
AK Folkins, NS Nevadunsky, EA Jarboe, MG Muto, CM Feltmate, CP Crum, MS Hirsch. Brigham and Women's Hospital, Boston, MA
Background: Total laparoscopic hysterectomy (TLH) is a minimally invasive procedure used to treat endometrial adenocarcinoma. Subsequent therapeutic decisions and prognosis are influenced by histologic findings, including the presence or absence of lymphovascular invasion (LVI). A recent report describing vascular pseudo invasion in a majority of TLH specimens with endometrial carcinoma has questioned how balloon tip intrauterine manipulators used in this procedure might affect the final pathology. To obtain a clearer understanding of the frequency of LVI following TLH, we compared pathologic findings in TLHs and total abdominal hysterectomies (TAHs) performed for uterine endometrioid adenocarcinoma.
Design: Reports from 58 TLHs performed with robotic assistance and 39 TAHs for grade 1 and 2 endometrioid endometrial adenocarcinomas were reviewed for stage, depth of invasion, LVI, and lymph node (LN) metastasis. Additionally, some cases were reviewed to determine if there are histologic findings that can reproducibly distinguish TLH from TAH.
Results: Nine of 58 (16%) TLHs and 4 of 39 (10%) TAHs showed LVI (p>0.10). TLHs+LVI ranged from FIGO stage 1A to 3C (with 44% >stage 1C), whereas TAHs+LVI ranged from FIGO stage 1C to 3C (100% > stage 1C). Half (2/4) of the TAH+LVI cases had positive LNs; in contrast, LNs were only positive in 11% (1/9) of the TLH+LVI cases. When two pathologists blindly reviewed 10 cases with LVI, they accurately distinguished the TLH and TAH cases in 9 out of 10 and 7 out of 10 times, respectively, based on the presence of endomyometrial vertical clefts and inflammatory debris in vascular spaces, a likely result of increased intrauterine pressure.
Conclusions: The prevalence of LVI did not significantly differ between TLH and TAH cases in our series, but LVI in TLH cases was associated more frequently with lower stage/depth of invasion and percentage of LN metastases. These more favorable features in TLHs raise the possibility that LVI in some of these cases may in fact be artificial (vascular pseudo invasion). The presence of sensitive histologic findings (i.e. vertical clefts and intravascular inflammatory debris) in TLH cases should cause the pathologist to consider the possibility that LVI may be artifactual. Nevertheless, the clinical significance of vascular pseudo invasion remains unclear.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 158, Wednesday Afternoon