The impact of examining VEGF-C expression, D2-40-based detection of LVI, and LVD on the prediction of lymph node metastasis in endometrial carcinoma

Abstract

Shaimaa Kamal Dawa, Omneya Youssef Bassyoni

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