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Updated: Oct 28, 2025

Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
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Defining Substantial Lymphovascular Space Invasion in Endometrial Cancer.

Elke E M Peters, Alicia León-Castillo, Vincent T H B M Smit

    International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists
    |July 15, 2021
    PubMed
    Summary
    This summary is machine-generated.

    Quantifying lymphovascular space invasion (LVSI) in endometrial cancer (EC) is crucial. A threshold of ≥4 involved vessels defines clinically relevant LVSI, improving recurrence risk assessment.

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    Area of Science:

    • Gynecologic Oncology
    • Pathology
    • Cancer Research

    Background:

    • Lymphovascular space invasion (LVSI) is a key prognostic factor in endometrial cancer (EC).
    • Accurate assessment of LVSI extent is vital for predicting recurrence and metastasis.
    • Current methods for quantifying LVSI lack reproducibility, necessitating standardized criteria.

    Purpose of the Study:

    • To quantitatively analyze the correlation between LVSI extent and pelvic lymph node recurrence risk in EC.
    • To establish a reproducible, quantitative threshold for defining clinically meaningful LVSI in endometrial cancer.
    • To improve the differentiation between focal and substantial LVSI in pathological assessment.

    Main Methods:

    • Quantitative analysis of LVSI in EC samples from PORTEC-1 and PORTEC-2 trials.
    • Counting LVSI-positive vessels per H&E-stained slide.
    • Kaplan-Meier and Cox regression analyses to assess recurrence risk based on LVSI vessel count, validated in the DGCD cohort.

    Main Results:

    • A 5-year pelvic lymph node recurrence risk of 26.3% was observed with ≥4 LVSI-involved vessels, compared to 3.3% with 0 vessels (P<0.001).
    • Significant differences in tumor cell burden and number of involved slides were found between focal and substantial LVSI.
    • Similar correlations between LVSI extent and recurrence risk were confirmed in the DGCD cohort.

    Conclusions:

    • A proposed numeric threshold of ≥4 LVSI-involved vessels in at least one H&E slide defines clinically relevant LVSI in EC.
    • This quantitative approach enhances the reproducibility of LVSI assessment in gynecologic pathology.
    • Standardizing LVSI quantification aids in risk stratification and clinical decision-making for endometrial cancer patients.