Lymphovascular Space Invasion in Cervical Cancer: A Review of Clinical Significance and Pathologic Issues

Lymphovascular space invasion (LVSI) is defined as tumor cells within blood vessels or lymphatic endothelial-lined spaces and, until recently, its prognostic significance in cervical cancer was somewhat controversial and less well studied than for some other tumor types in the female genital tract. Based on the available literature, there is now strong evidence that LVSI is not only a significant prognostic factor, especially in early-stage cervical cancers (squamous cell carcinomas and adenocarcinomas), but is also a predictive factor for lymph node metastases. Consequently, while LVSI does not impact FIGO or TNM staging, its presence should be recorded in the pathology report and considered in management decisions regarding adjuvant treatment, as suggested by various international guidelines. More recently, the extent of LVSI (substantial vs. focal vs. negative) has been demonstrated to predict survival in cervical cancer, although this is an area where more study is required both to determine whether substantial LVSI is of prognostic significance and to ascertain the optimal definition of substantial LVSI. LVSI can be diagnosed on routine microscopic examination without ancillary tests in most cases and thus can be reported even in low-resource settings. There are, however, various pathologic issues both in diagnosing and quantifying LVSI, with no universal recommendations. In this review, we examine the significance of LVSI in cervical cancer in terms of prognostication and in dictating the need for adjuvant treatment. We also discuss practical issues related to the pathologic reporting of LVSI.