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

Background: 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 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 were 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 , PPV, NPV, and accuracy of (100, 51.6, 62.5, 100, 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 9/9of EC with LNM cases ,(sensetivity100%) compared to 7/9 cases detected by H&E staining (sensetivity77.8%). D2-40 -LVI detection system could predict LNM with sensitivity, specificity, PPV, NPV, and accuracy of (100, 67.7, 47.4, 100, 75%. )respectively. D2-40-LVI ,Peritumoral LVD, and VEGF-C expression showed a significant correlation to LNM (p