Reproducibility of lymphovascular space invasion (LVSI) assessment in endometrial cancer

Histopathology. 2019 Jul;75(1):128-136. doi: 10.1111/his.13871. Epub 2019 Jun 10.

Abstract

Aims: Lymphovascular space invasion (LVSI) in endometrial cancer (EC) is an important prognostic variable impacting on a patient's individual recurrence risk and adjuvant treatment recommendations. Recent work has shown that grading the extent of LVSI further improves its prognostic strength in patients with stage I endometrioid EC. Despite this, there is little information on the reproducibility of LVSI assessment in EC. Therefore, we designed a study to evaluate interobserver agreement in discriminating true LVSI from LVSI mimics (Phase I) and reproducibility of grading extent of LVSI (Phase II).

Methods and results: Scanned haematoxylin and eosin (H&E) slides of endometrioid EC (EEC) with a predefined possible LVSI focus were hosted on a website and assessed by a panel of six European gynaecological pathologists. In Phase I, 48 H&E slides were included for LVSI assessment and in Phase II, 42 H&E slides for LVSI grading. Each observer was instructed to apply the criteria for LVSI used in daily practice. The degree of agreement was measured using the two-way absolute agreement average-measures intraclass correlation coefficient (ICC). Reproducibility of LVSI assessment (ICC = 0.64, P < 0.001) and LVSI grading (ICC = 0.62, P < 0.001) in EEC was substantial among the observers.

Conclusions: Given the good reproducibility of LVSI, this study further supports the important role of LVSI in decision algorithms for adjuvant treatment.

Keywords: LVSI; LVSI grading; endometrial neoplasms; interobserver study; lymphovascular space invasion; observer variation.

Publication types

  • Clinical Trial, Phase I
  • Clinical Trial, Phase II

MeSH terms

  • Carcinoma, Endometrioid / pathology
  • Carcinoma, Endometrioid / secondary*
  • Endometrial Neoplasms / pathology*
  • Female
  • Humans
  • Lymphatic Metastasis / diagnosis
  • Lymphatic Metastasis / pathology*
  • Lymphatic Vessels / pathology
  • Neoplasm Grading / methods
  • Neoplasm Invasiveness / diagnosis
  • Neoplasm Invasiveness / pathology
  • Observer Variation
  • Prognosis
  • Reproducibility of Results