Background: Lymph node metastasis (LNM) is a main route of endometrial carcinoma (EC) spread and it plays a chief prognostc role. Our objectve is to fnd LMN predictors through investgatng lymph vessel invasion (LVI) and lymphatc vessel density (LVD), in additon to vascular endothelial growth factor -C (VEGF-C) expression in the primary tumor site of the EC. Material and Methods: A retrospectve immunohistochemical study applying VEGF-C and D2-40 antbodies on 40 EC cases, in additon to 20 cases of proliferatve endo- metrium, and 20 cases with atypical endometrial hyperplasia as control groups. The studied cases were screened for expression of VEGF-C, D2-40-LVI, and LVD. Statstcal analysis with the correlaton of the fndings to various clinicopathological parameters was achieved.
Results: Expression of VEGF-C was moderate-to-high in 87.5% of EC cases, only mild-to-moderate focal staining in atypical hyperplasia cases, and exclusively negatve in proliferatve endometrium cases. VEGF-C expression could independently predict LNM with sensitvity, specifcity, positve predictve value (PPV), negatve predictve value (NPV), and accuracy of 100%, 51.6%, 62.5%, 100%, and 62.5%, respectvely. D2-40-LVI detecton system is more sensitve in predictng LNM in EC than routne H&E stained secton. It was detected in 9/9 of EC with LNM cases (sensetvity 100%) compared with 7/9 cases detected by H&E staining (sensetvity 77.8%). D2-40-LVI detecton system could predicit LNM with sensitvity, specifcity, PPV, NPV, and accuracy of 100%, 67.7%, 47.4%, 100%, and 75%, respectvely. D2-40-LVI, peritumoral LVD, and VEGF-C expression showed a signifcant correlaton to LNM (p < 0.05) and each one of them can indepen- dentatly predict LNM (AUC = 0.839, 0.703, and 0.758), respectvely.
Conclusions: Evaluaton of LVI, peritumoral LVD by D2-40, and VEGF-C expression in EC at the primary tumor site can predict LNM and helps the clinicians to select the patent who will need further lymphadenectomy. |
