DEMYSTIFYING THE ENIGMA OF MELF AND LYMPHOVASCULAR INVASION IN ENDOMETRIAL CARCINOMA – AN IN DEPTH ANALYSIS

Abstract

INTRODUCTION :

Endometrial carcinoma is impacted by various prognostic factors, among which lymphovascular invasion (LVI) has recently added prominence in evaluating the hazard associated with early endometrioid endometrial carcinoma and in determining the potential benefits of adjuvant radiation therapy for patients.In order to accurately evaluate LVI in early-stage endometrioid endometrial cancer, this study focuses on grading and determining its extent.. Additionally, the study proposes local recommendations aimed at enhancing the repeatablity of LVI evaluation in endometrial carcinoma, offering insights to plan further investigation activities.

MATERIALS AND METHODS :

In this retrospective study spanning two years, cases included early-stage Ia and Ib endometrioid endometrial carcinomas of grade 1 and 2. Three independent reviewers meticulously documented their observations based on H&E stained slides, categorizing LVI as absent, focal, or significant. In samples where discrepancies arose, the immunohistochemical stain CD 31 was utilized for further clarification. All data were meticulously entered into SPSS version 26 for comprehensive statistical analysis, including frequency distributions and evaluations of the associations with different histological factors and the consistency of LVI assessments among different researchers.

RESULTS :

Among the initial 70 samples of endometrioid carcinoma identified in hysterectomy specimens, only 32 cases satisfied the stringent inclusion criteria for this study. The rates of LVI positivity varied among reviewers, with percentages of 6.3%, 34.4%, and 37.5% respectively for reviewers 1, 2, and 3. Notably, significant consistency was observed in LVI evaluation and categorizing specifically between assessors 2 and 3. Furthermore, a statistically noteworthy correlation was established amongst tumor grade and the presence of LVI.

CONCLUSION :

  In spite of inherent restrictions in our study, we advocate for the routine inclusion of both LVI evaluation and its grading in local result protocols. We suggest implementing a dual-reviewer system for LVI assessment and employing CD 31 staining in cases where discrepancies in LVI status occur, as these measures have the potential to substantially enhance the detection of LVI(1). These recommendations aim to standardize and improve the accuracy of LVI evaluation in clinical practice, potentially influencing treatment decisions in early-stage endometrial carcinoma.