Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Weber, S.
Retrospective assessment of LVSI in stage I endometrioid adenocarcinoma of the uterus using digital pathology
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2024. pp. 70
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Abete Luca
- Regitnig Peter
- Altmetrics:
- Abstract:
- Background: in contrast to non-endometrioid histotypes, endometrioid adenocarcinoma of the uterine corpus are mostly associated with an overall favourable prognosis and get mostly treated with just surgery. However, staging, grading and along with different other independent prognostic factors influence the outcome. One of these factors is lymph-vascular space invasion (LVSI), which is a known negative prognostic factor in endometrioid endometrial cancer and influences treatment options. Due to the prognostic and therapeutical importance the World Health Organisation (WHO) and the ESGO/ESTRO/ESP guidelines provide criteria for LVSI evaluation and interpretation. By using a three-tiered scoring system (no LVSI, focal LVSI, substantial LVSI), they state that only substantial LVSI (defined as 5 or more LVSI) is of prognostic significance, whereas focal LVSI (defined as <5 LVSI) is not. Most recently, substantial LVSI has been incorporated in the current version of FIGO staging (2023). The ESGO/ESTRO/ESP guidelines are the only ones which also differentiate between unifocal and multifocal LVSI, considering the latter automatically as substantial. In a retrospective study we investigated the many aspects of LVSI, evaluated number, spatial distribution and depth of LVSI and correlated them with clinical outcome. Method: all diagnosed endometrioid endometrial cancer cases between the year 2004 and 2018, with N0, L1, FIGO Stage I, G1-G3 have been included. Further clinical data regarding cancer recurrence or death has been noted. In total 25 eligible cases were retrieved and analysed. All tumour slides were scanned and with the help of QuPath all LVSI have been marked and could be used for further calculations. The total number of LVSI for each case was counted. Further, it was investigated if they had the tendency to aggregate in clusters (foci). Different cluster diameters (0,5mm, 1mm, 2mm, 3mm, 4mm) have been tested and the number of clusters per case was documented. The relation between number of cluster and cancer recurrence and death was assessed. An association between deep location of LVSI and outcome was also investigated. Results: In this study it could be observed that substantial and diffuse LVSI have a higher risk for cancer recurrence and are associated with a higher mortality, compared to focal LVSI. Further, it could be verified that the cut-off of 5 LVSI is adequate. What is more, we found that unifocality, defined as presence of a single focus with <5 LVSI, was not associated with worse outcome, as recurrence and death were only seen in cases with multifocality, the vast majority of which had also at least 5 LVSI in total. Considering the low number of borderline cases with bifocality and small number of total LVSI in our cohort, it was not possible to collect evidence that a multifocal distribution of LVSI automatically defines a higher risk. Further, we observed a strong association between deep location of LVSI in the myometrium and adverse outcome. Conclusion: In this work it could be proven that only substantial LVSI plays a key role in the prognosis and that the used cut-off according to international guidelines is adequate to differentiate between focal and substantial LVSI. The use of digital pathology proved itself to be a very useful tool in examining LVSI and should be used for further investigations regarding multifocality and to determine the prognostic value in future studies with a larger number of patients, as it was not possible due to our small cohort to prove its impact. The deep location of LVSI in the myometrium was in our study a strong indicator of decreased survival and should be observed in future studies.