open access

Vol 90, No 6 (2019)
Research paper
Published online: 2019-06-28
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Lower uterine segment involvement in lymphovascular space invasion and lymph node metastasis in endometrioid endometrial cancer

Hakan Cokmez1, Alpay Yilmaz1
·
Pubmed: 31276182
·
Ginekol Pol 2019;90(6):314-319.
Affiliations
  1. Department of Obstetrics and Gynecology, Izmir Ataturk Education and Research Hospital, Karabaglar, Izmir, Turkey

open access

Vol 90, No 6 (2019)
ORIGINAL PAPERS Gynecology
Published online: 2019-06-28

Abstract

Objectives: To evaluate the correlation between lymphovascular space invasion (LVSI) indicating lower uterine segment involvement (LUSI) in endometrioid endometrial cancer and lymph node metastasis based on the lymphatic drainage difference between the uterine corpus and the lower segment. 

Material and methods: Patients who underwent staging surgery for endometrioid endometrial cancer between January 2010 and January 2019 at our institution were reviewed. The clinicopathologic findings and LUSI status of the patients were compared with their LVSI and lymph node metastasis status. 

Results: Of the 253 patients included in this study, 49 (19.4%) had LUSI. Among these patients, none of the 31 LVSI-negative patients had metastatic lymph node involvement. However, of the 18 LVSI-positive patients, half had metastatic lymph node involvement; this difference was significant (p < 0.05). 

Conclusions: The significant correlation between LVSI and lymph node metastasis in LUSI-positive cases indicates that pathologists should also focus on LVSI findings in the frozen examination required for the decision of staging surgery in patients with endometrioid endometrial cancer limited to the uterus. This is especially important in patients with a lower uterine segment involvement.

Abstract

Objectives: To evaluate the correlation between lymphovascular space invasion (LVSI) indicating lower uterine segment involvement (LUSI) in endometrioid endometrial cancer and lymph node metastasis based on the lymphatic drainage difference between the uterine corpus and the lower segment. 

Material and methods: Patients who underwent staging surgery for endometrioid endometrial cancer between January 2010 and January 2019 at our institution were reviewed. The clinicopathologic findings and LUSI status of the patients were compared with their LVSI and lymph node metastasis status. 

Results: Of the 253 patients included in this study, 49 (19.4%) had LUSI. Among these patients, none of the 31 LVSI-negative patients had metastatic lymph node involvement. However, of the 18 LVSI-positive patients, half had metastatic lymph node involvement; this difference was significant (p < 0.05). 

Conclusions: The significant correlation between LVSI and lymph node metastasis in LUSI-positive cases indicates that pathologists should also focus on LVSI findings in the frozen examination required for the decision of staging surgery in patients with endometrioid endometrial cancer limited to the uterus. This is especially important in patients with a lower uterine segment involvement.

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Keywords

endometrial cancer; lower uterine segment; lymphovascular space invasion; lymph node metastasis

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About this article
Title

Lower uterine segment involvement in lymphovascular space invasion and lymph node metastasis in endometrioid endometrial cancer

Journal

Ginekologia Polska

Issue

Vol 90, No 6 (2019)

Article type

Research paper

Pages

314-319

Published online

2019-06-28

Page views

2309

Article views/downloads

1261

DOI

10.5603/GP.2019.0057

Pubmed

31276182

Bibliographic record

Ginekol Pol 2019;90(6):314-319.

Keywords

endometrial cancer
lower uterine segment
lymphovascular space invasion
lymph node metastasis

Authors

Hakan Cokmez
Alpay Yilmaz

References (34)
  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  2. Bosse T, Peters EEM, Creutzberg CL, et al. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer--A pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer. 2015; 51(13): 1742–1750.
  3. Jorge S, Hou JY, Tergas AI, et al. Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer. Gynecol Oncol. 2016; 140(3): 387–393.
  4. Bendifallah S, Canlorbe G, Raimond E, et al. A clue towards improving the European Society of Medical Oncology risk group classification in apparent early stage endometrial cancer? Impact of lymphovascular space invasion. Br J Cancer. 2014; 110(11): 2640–2646.
  5. Sadozye AH, Harrand RL, Reed NS. Lymphovascular Space Invasion as a Risk Factor in Early Endometrial Cancer. Curr Oncol Rep. 2016; 18(4): 24.
  6. Vaizoglu F, Yuce K, Salman MC, et al. Lymphovascular space involvement is the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer. Arch Gynecol Obstet. 2013; 288(6): 1391–1397.
  7. Taşkın S, Şükür YE, Varlı B, et al. Nomogram with potential clinical use to predict lymph node metastasis in endometrial cancer patients diagnosed incidentally by postoperative pathological assessment. Arch Gynecol Obstet. 2017; 296(4): 803–809.
  8. Sahin H, Meydanli MM, Sari ME, et al. Recurrence patterns and prognostic factors in lymphovascular space invasion-positive endometrioid endometrial cancer surgically confined to the uterus. Taiwan J Obstet Gynecol. 2019; 58(1): 82–89.
  9. Geppert B, Lönnerfors C, Bollino M, et al. A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2017; 145(2): 256–261.
  10. Chan JK, Urban R, Cheung MK, et al. Lymphadenectomy in endometrioid uterine cancer staging: how many lymph nodes are enough? A study of 11,443 patients. Cancer. 2007; 109(12): 2454–2460.
  11. Mariani A, Dowdy SC, Cliby WA, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008; 109(1): 11–18.
  12. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997; 20(7): 1183–1197.
  13. Tavassoli FA, Devilee P. Pathology and genetics. Tumors of the breast and female genital organs. WHO Classification of Tumors. In: Silverberg SG, Kurman RJ, Nogales F, Mutter GL, Kubik-Huch RA, (eds). Epithelial tumors and related lesions. Tumors of the Uterine Corpus. Lyon: IARC Press. ; 2003: 221–228.
  14. Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006; 95 Suppl 1: S105–S143.
  15. Mariani A, Dowdy SC, Cliby WA, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008; 109(1): 11–18.
  16. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009; 105(2): 103–104.
  17. Nithin KU, Sridhar MG, Srilatha K, et al. CA 125 is a better marker to differentiate endometrial cancer and abnormal uterine bleeding. Afr Health Sci. 2018; 18(4): 972–978.
  18. Hachisuga T, Kaku T, Enjoji M. Carcinoma of the Lower Uterine Segment. Clinicopathologic Analysis of 12 Cases. International Journal of Gynecological Pathology. 1989; 8(1): 26–35.
  19. Erkaya S, Öz M, Topçu HO, et al. Is lower uterine segment involvement a prognostic factor in endometrial cancer? Turk J Med Sci. 2017; 47(1): 300–306.
  20. Gemer O, Gdalevich M, Voldarsky M, et al. Lower uterine segment involvement is associated with adverse outcome in patients with stage I endometroid endometrial cancer: results of a multicenter study. Eur J Surg Oncol. 2009; 35(8): 865–869.
  21. Miyoshi Ai, Kanao S, Naoi H, et al. Investigation of the clinical features of lower uterine segment carcinoma: association with advanced stage disease and indication of poorer prognosis. Arch Gynecol Obstet. 2018; 297(1): 193–198.
  22. Koskas M, Bassot K, Graesslin O, et al. Impact of lymphovascular space invasion on a nomogram for predicting lymph node metastasis in endometrial cancer. Gynecol Oncol. 2013; 129(2): 292–297.
  23. Sarı ME, Meydanlı MM, Yalçın I, et al. Risk Factors for Lymph Node Metastasis among Lymphovascular Space Invasion-Positive Women with Endometrioid Endometrial Cancer Clinically Confined to the Uterus. Oncol Res Treat. 2018; 41(12): 750–754.
  24. Sari ME, Yalcin İ, Sahin H, et al. Risk factors for paraaortic lymph node metastasis in endometrial cancer. Int J Clin Oncol. 2017; 22(5): 937–944.
  25. Kumar S, Bandyopadhyay S, Semaan A, et al. The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One. 2011; 6(9): e21912.
  26. Yasa C, Takmaz O, Dural O, et al. The Value of Tumor Markers in Endometrial Carcinoma: Review of Literature. J Cancer Ther. 2013; 04(05): 966–970.
  27. Neal SA, Graybill WS, Garrett-Mayer E, et al. Lymphovascular space invasion in uterine corpus cancer: What is its prognostic significance in the absence of lymph node metastases? Gynecol Oncol. 2016; 142(2): 278–282.
  28. Westin SN, Lacour RA, Urbauer DL, et al. Carcinoma of the lower uterine segment: a newly described association with Lynch syndrome. J Clin Oncol. 2008; 26(36): 5965–5971.
  29. Ismiil N, Rasty G, Ghorab Z, et al. Adenomyosis involved by endometrial adenocarcinoma is a significant risk factor for deep myometrial invasion. Ann Diagn Pathol. 2007; 11(4): 252–257.
  30. Gizzo S, Patrelli TS, Dall'asta A, et al. Coexistence of adenomyosis and endometrioid endometrial cancer: Role in surgical guidance and prognosis estimation. Oncol Lett. 2016; 11(2): 1213–1219.
  31. Kizer NT, Gao F, Guntupalli S, et al. Lower uterine segment involvement is associated with poor outcomes in early-stage endometrioid endometrial carcinoma. Ann Surg Oncol. 2011; 18(5): 1419–1424.
  32. Lavie O, Uriev L, Gdalevich M, et al. The outcome of patients with stage I endometrial cancer involving the lower uterine segment. Int J Gynecol Cancer. 2008; 18(5): 1079–1083.
  33. Hahn HS, Lee IH, Kim TJ, et al. Lymphovascular space invasion is highly associated with lymph node metastasis and recurrence in endometrial cancer. Aust N Z J Obstet Gynaecol. 2013; 53(3): 293–297.
  34. Laufer J, Scasso S, Papadia A, et al. Association between tumor diameter and lymphovascular space invasion among women with early-stage endometrial cancer. Int J Gynaecol Obstet. 2013; 123(2): 142–145.

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