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Lymphovascular Space Invasion for Endometrial Cancer: Undertreatment and Overtreatment Risks
  1. Mikel Gorostidi Pulgar, MD, MS*,
  2. Begoña Diaz de la Noval, MD,
  3. Blanca Gil-Ibañez, MD, PhD,
  4. Victor Lago Leal, MD§,
  5. Ibon Jaunarena Marin, MD* and
  6. Pablo Padilla Iserte, MD§
  1. * Hospital Universitario Donostia, San Sebastián;
  2. La Paz University Hospital, Madrid;
  3. Hospital Vall d’Hebron, Barcelona; and
  4. § Valencian Institute of Oncology, Valencia, Spain.
  1. Address correspondence and reprint requests to Mikel Gorostidi Pulgar, MD, MS, Departamento de Obstetricia y Ginecología, Hospital Universitario Donostia, P. Beguiristain s/n, 20014 San Sebastián, Spain. E-mail: mgorostidi{at}


Objective The purpose of this study is to asses the impact of lymphovascular space invasion (LVSI) present in early-stage endometrial cancer, regarding its therapeutic management and prognosis knowledge, based on a survey among Spanish oncologic gynecologist.

Methods/Materials Between October and November 2014, the Young Spanish Onco-gynecologist Group carried out a survey to perform a cross-sectional study about the management of LVSI. All active members in the oncology field of the Spanish Society of Gynecology and Obstetrics were invited to participate in the survey.

Results Most respondents consider LVSI a bad prognosis factor for endometrial cancer (66%) and also consider that it should be included in the International Federation of Gynecology and Obstetrics classification (56%). Seventy-five percent of all gynecologists did not modify their surgical treatment. Regarding follow-up, 38% of the respondents do not change their surveillance, 28% modify it, and 31% reported any change only with additional factors. Forty-seven percent of respondents advise systemic treatment with chemotherapy.

Data were dichotomized between less than or equal to 20 versus greater than 20 years of OB-GYN specialist and less than or equal to 5 versus greater than 5 years of main dedication to gynecology oncology, but it was not possible to show any significant differences among the groups. The response rate (34 individuals) was too low to expect any significant differences.

Conclusions Results suggest that LVSI remains a controversial issue in the management of patients with endometrial cancer. Acquiring a deeper knowledge and uniform criteria could avoid the risk of undertreatment and overtreatment in this group of patients with early-stage endometrial cancer. The identification of vascular pseudoinvasion is recommended, although the clinical and prognostic implications still need to be determined.

  • Adjuvant therapy
  • Endometrial carcinoma
  • Lymphovascular space invasion
  • Vascular pseudoinvasion

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  • The authors declare no conflicts of interest.