International journal of clinical oncology · 2026
Impact of lymphovascular space invasion on lymph node metastasis in low-grade endometrial cancer with shallow myometrial invasion and negative imaging.
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Yoshimitsu Teruyuki, Nomura Hidetaka, Watanabe Toshiaki, Misaka Satoki, Butsuhara Yusuke, Nishino Shogo, Kamata Mayumi, Kanno Motoko, Abe Akiko, Fusegi Atsushi, Omi Makiko, Aoki Yoichi, Netsu Sachiho, Tanigawa Terumi, Okamoto Sanshiro, Yunokawa Mayu, Kanao Hiroyuki
Аннотация
BACKGROUND: This study aimed to determine the frequency of lymph node metastasis in endometrioid carcinomas of grades 1 or 2 with shallow myometrial invasion and lymphovascular space invasion (LVSI).
METHODS: After obtaining institutional review board approval, we retrospectively reviewed the medical records of 112 patients with endometrial cancer who were treated at our hospital between January 2007 and December 2022. These patients met the following criteria: endometrioid carcinoma grade 1 or 2, myometrial invasion less than 50%, and preoperative CT showing regional lymph nodes with a short diameter less than 10 mm. All patients underwent pelvic and para-aortic lymphadenectomies.
RESULTS: Lymph node metastasis was identified in 8 (7.1%) cases. LVSI was significantly associated with lymph node metastasis (odds ratio 10.19, 95% CI 2.35-61.33, P-value: 0.002). LVSI was present in 26 (23.2%) of the 112 cases, and among these, 6 (23.1%) had lymph node metastasis. Of the patients with lymph node involvement, 5 (62.5%) had only pelvic metastases, 2 (25%) had only para-aortic metastases, and 1 (12.5%) had both pelvic and para-aortic metastases. Pathological re-evaluation of node-positive cases revealed macrometastases in 5 patients and micrometastases in 3 patients.
CONCLUSION: Even in endometrioid carcinoma grade 1-2 with shallow myometrial invasion and no radiologic evidence of lymph node metastasis, lymph node metastasis was observed in a substantial proportion of LVSI-positive cases. These findings highlight the importance of postoperative pathological risk assessment and suggest that occult nodal disease may be present even in patients considered low risk preoperatively.
METHODS: After obtaining institutional review board approval, we retrospectively reviewed the medical records of 112 patients with endometrial cancer who were treated at our hospital between January 2007 and December 2022. These patients met the following criteria: endometrioid carcinoma grade 1 or 2, myometrial invasion less than 50%, and preoperative CT showing regional lymph nodes with a short diameter less than 10 mm. All patients underwent pelvic and para-aortic lymphadenectomies.
RESULTS: Lymph node metastasis was identified in 8 (7.1%) cases. LVSI was significantly associated with lymph node metastasis (odds ratio 10.19, 95% CI 2.35-61.33, P-value: 0.002). LVSI was present in 26 (23.2%) of the 112 cases, and among these, 6 (23.1%) had lymph node metastasis. Of the patients with lymph node involvement, 5 (62.5%) had only pelvic metastases, 2 (25%) had only para-aortic metastases, and 1 (12.5%) had both pelvic and para-aortic metastases. Pathological re-evaluation of node-positive cases revealed macrometastases in 5 patients and micrometastases in 3 patients.
CONCLUSION: Even in endometrioid carcinoma grade 1-2 with shallow myometrial invasion and no radiologic evidence of lymph node metastasis, lymph node metastasis was observed in a substantial proportion of LVSI-positive cases. These findings highlight the importance of postoperative pathological risk assessment and suggest that occult nodal disease may be present even in patients considered low risk preoperatively.