Clinical Significance of Lymphovascular Space Invasion in Uterine Serous Carcinoma
Sudeshna Bandyopadhyay, Ira Winer, Ismail Mert, Esther Oliva, Marisa Nucci, Zaid Al-Wahab, Hui Guan, Haitham Arabi, Baraa Alosh, Koen K Van de Vijver, Rouba Ali-Fehmi. Wayne State University, Detroit, MI; Massachusetts General Hospital, Boston, MA; Brigham and Women's Hospital, Boston, MA; King Abdulaziz Medical City, Jiddah, Saudi Arabia
Background: Uterine serous carcinoma, although less common, is responsible for a larger proportion of uterine cancer related deaths. Vascular space invasion has been identified as a prognostic factor. The aim of our study was to analyze the clinical significance of extensive, low or absence of lymphovascular space invasion (LVSI) in uterine serous carcinoma (USC) patients.
Design: After IRB approval, 236 USC from the pathology databases of 4 large academic institutions were included. H&E slides (2-10 slides per case) were retrieved and reviewed by a gynecologic pathologist at each participating institution after reviewing 50 cases as a group to be consistent in the diagnosis. LVSI information was available for 151 patients. Patients were divided into three groups based on LVSI extent. Extensive LVSI (E-LVSI) was defined as ≥ 3 vessel involvement; Low LVSI (L-LVSI) was defined as less than 3 vessel involvement and the last group was absent LVSI (A-LVSI).
Results: Out of these 151 patients, 65 had A-LVSI, 55 had L-LVSI, and 31 had E-LVSI. Please see table for the association between LVSI and LN involvement, washing, myometrial invasion, cervical involvement, lower uterine segment involvement (LUS), and stage. Analyzing only stage I and stage II disease (n=68) for survival and recurrence, demonstrated a median survival of 177 months, 155 months and 34 months in the A-LVSI, L-LVSI and E-LVSI groups.
|A-LVSI (65)||L-LVSI (55)||E-LVSI (31)|
|+ LN||15.4%||27.3 %||83.9%||*|
|+ Washing||18.8 %||24 %||37 %||NS|
|Myometrial Invasion||58 %||85 %||100%||*|
|Cervical Invasion||23 %||43 %||66 %||*|
|Lower Uterine Segment Invasion||34 %||55 %||77 %||*|
|Stage III & IV||31 %||40 %||78 %||*|