Assessment of lymphovascular space invasion in cervical squamous cell carcinoma using digital pathology: a...

Lymphovascular space invasion (LVSI) is associated with increased nodal involvement and disease recurrence in cervical squamous cell carcinoma (SCC). While LVSI is currently included in some clinical risk assessment algorithms, the reproducibility of diagnosing LVSI remains understudied in cervical SCC. We aimed to assess the inter-observer agreement for LVSI diagnosis using digital whole slide images (WSIs) of haematoxylin and eosin-stained (H&E) slides with presumed true LVSI (n = 20) and LVSI mimics (n = 20) from early-stage cervical SCC identified in an international cohort.

The reference diagnosis for LVSI status was established by 2 pathologists through consensus review. Ten independent pathologists from North and South America, Europe, Asia and South Africa were included for blinded scoring of true LVSI versus LVSI mimics. Complete concordance was seen in 57% of cases. Overall percent agreement was 88% with the κ value being 0.76, reflecting substantial agreement on LVSI diagnosis based on H&E WSIs.

Our findings support the diagnostic feasibility and reliability of including LVSI as a parameter in routine histologic evaluation for risk stratification of cervical SCC. While the inter-observer agreement in our study is acceptable, there remains a need for standardised diagnostic criteria and guidance on the use of immunohistochemical studies for the detection or confirmation of LVSI in daily practice.