Background:Lymph node metastasis (LNM) is a main route of endometrial carcinoma (EC)
spread and it plays a chief prognostic role. Our objective is to find LMN predictors through
investigating lymph vessel invasion (LVI) and lymphatic vessel density (LVD), in addition to
vascular endothelial growth factor -C (VEGF-C) expression in the primary tumor site of the EC.
Material and Methods:A retrospective immunohistochemical study applying VEGF-C
and D2-40 antibodies on 40 EC cases, in addition to 20 cases of proliferative endometrium, 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. Statistical
analysis with the correlation of the findings 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 negative in
proliferative endometrium cases. VEGF-C expression could independently predict LNM
with sensitivity, specificity, positive predictive value (PPV), negative predictive value
(NPV), and accuracy of 100%, 51.6%, 62.5%, 100%, and 62.5%, respectively. D2-40-LVI
detection system is more sensitive in predicting LNM in EC than routine H&E stained
section. It was detected in 9/9 of EC with LNM cases (sensetivity 100%) compared with
7/9 cases detected by H&E staining (sensetivity 77.8%). D2-40-LVI detection system
could predicit LNM with sensitivity, specificity, PPV, NPV, and accuracy of 100%, 67.7%,
47.4%, 100%, and 75%, respectively. D2-40-LVI, peritumoral LVD, and VEGF-C expression
showed a significant correlation to LNM (p < 0.05) and each one of them can independentatly predict LNM (AUC = 0.839, 0.703, and 0.758), respectively.
Conclusions:Evaluation 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 patient
who will need further lymphadenectomy.