Research Article

Assessment of Lymphovascular Space Invasion Extent in Endometrial Carcinoma by Serial Histological Sectioning

Abstract

Background: The extent of lymphovascular space invasion (LVSI) is important in risk assessment for endometrial carcinoma, and pathology sampling can prove challenging. Objective: To assess the added value of serial histological levels in detecting LVSI, extent classification and diagnosis. Methodology: The study was carried out as a retrospective paired study involving 60 hysterectomy specimens from women of Basrah, Iraq. Single-level baseline and 20-level serial H&E assessment with independent review and adjudication was undertaken for Ninety blocks. Substantial LVSI > four separate distinct involvement vessels per section (not cumulative from section to section). Results: Of 1,800 planned levels, 1,764 (98.0%) were interpretable. Among 54 definite extent pairs, substantial LVSI increased from 8/54 (14.8%) to 15/54 (27.8%), a difference of 13.0 percentage points (95% CI, 2.6–25.2; p=0.0391). For eight cases, LVSI was reclassified as substantial; for one, to focal. There were 18 substantial cases in the full study cohort, three of which initially had indeterminate extent. Among 56 definite presence pairs, detection increased from 26/56 (46.4%) to 32/56 (57.1%; p=0.0313), with six newly positive cases. There were 21 cases where the numbers of vessels increased and three where the numbers of vessels decreased (p=0.000277). Three of four presence-indeterminate cases and four of six extent-indeterminate cases were resolved by serial assessment. In one case, secondary clarification was obtained by immunohistochemistry using ERG and CD31 as a marker, which was unavailable in the second case. Conclusion: Serial assessment reduced diagnostic uncertainty and serial levels improved the detection and substantial classification of LVSI. Further validation for clinical relevance and implementation is needed.

Authors affiliation:

Sahira Yaqoot Rwayeh Al-Asadi (ORCID): Basrah Education Directorate, Ministry of Education, Basrah, Iraq.

How To Cite: S.Y.R. Al-Asadi. Assessment of Lymphovascular Space Invasion Extent in Endometrial Carcinoma by Serial Histological Sectioning. Journal of Applied Health Sciences and Medicine, 6(11):7–16, 2026. https://doi.org/10.58614/jahsm6112