Peritumoral lymphatic microvessel density as a prognostic parameter in endometrial carcinoma

ABSTRACT

Lymphatic invasion and nodal metastasis play a major role in the spread and prognosis of endometrial adenocarcinoma [EC]. In this study, we investigated tumor lymph-angiogenesis, detected by D2-40, as a predictive marker for the risk of lymph node [LN] metastasis and its relation to other prognostic parameters in EC. Fifty-five cases of EC treated with total hysterectomy and pelvic LN dissection were reviewed. All cases were immunostained for D2-40. Positively stained microvessels [MV] were counted in densely lymphovascular foci [hotspots] at X400 field [0.17 mm[2]]. Lymphovascular invasion was detected in 20/55 patients by D2-40 and 14/55 by routine hematoxylin and eosin. Peritumoral lymphatic vessel [LV] count was significantly higher than intratumoral LV count [17+7 versus 5+4/0.17 mm[2], P< 0.01]. Peritumoral D2-40 lymphovascular count correlated significantly with FIGO grade [P <0.001], lymphovascular invasion [P=0.001] and lymph node [LN] metastases [P=0.005]. However it showed non-significant correlation with peritoneal wash positivity [P=0.830] and stage of the disease [P=0.341]. Lymphovascular invasion detected by D2-40 showed significant correlation with LN metastases [P<0.01]. Our study showed that assessing LVD with D2-40 in the endometrial carcinoma might be a valuable parameter for predicting patients having an increased risk of developing metastatic disease. In addition, D2-40 increases the frequency of detection of lymphatic invasion relative to routine hematoxylin and eosin stain