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Objective: Differentiated thyroid cancer (DTC) is the most common pediatric endocrine cancer but studies are scarce. Latest recommendations advocate for an individualized risk-based approach to select patients for additional therapy. Lymphovascular invasion is not considered, despite being a well-known risk factor in the adult population. The aim of this study was to describe the outcomes of a cohort of DTC patients diagnosed at pediatric age and to evaluate the impact of lymphovascular invasion on the risk of persistence/ recurrence. Methods: A retrospective study of patients diagnosed with DTC at pediatric age from 2010 to 2022 at a single center was performed. All patients had total thyroidectomy. Radioactive iodine therapy (RAI) was used in selected patients. The response to therapy and occurrence of persistent/recurrent disease were evaluated. Results: A total of 21 DTC were diagnosed, mostly papillary thyroid carcinoma (PTC) (81.0%, n=17). Six patients (28.6%) had nodal involvement and one (4.8%) had lung metastasis at the time of the diagnosis. Lymphovascular invasion was present in 11 patients (52.4%). After surgery, 13 patients (61.9%) underwent RAI. The mean follow-up time was 5.7±3.1 years. In total, 6 patients (31.6%) experienced persistent/recurrent disease during the follow-up time. Among PTC patients, persistent/recurrent disease was more frequent in the presence of lymphovascular invasion [55.6% (5/9) vs. 0.0% (0/6), p=0.031]. Conclusion: An individualized risk-based approach is recommended. Our study suggests that lymphovascular invasion may be associated with a higher risk of persistence/recurrence and should therefore be considered for decision making in children and adolescents with PTC. [ABSTRACT FROM AUTHOR]

Nodal status is well known to be the most important prognostic factor for esophageal cancer patients, even if they are treated with neoadjuvant therapy. To establish an optimal postoperative adjuvant strategy for patients, we aimed to more accurately predict the prognosis of patients and systemic recurrence by using clinicopathological factors, including nodal status, in patients with esophageal cancer who received neoadjuvant chemotherapy. The clinicopathological factors associated with survival and systemic recurrence were investigated in 488 patients with esophageal squamous cell carcinoma who received neoadjuvant chemotherapy. Overall survival differed according to tumor depth, nodal status, tumor regression, and lymphovascular (LV) invasion. In the multivariate analysis, nodal status and LV invasion were identified as independent prognostic factors (P  < 0.0001, P  = 0.0008). Nodal status was also identified as an independent factor associated with systemic recurrence, although LV invasion was a borderline factor (P  = 0.066). In each pN stage, patients with LV invasion showed significantly worse overall survival than those without LV invasion (pN0: P  = 0.036, pN1: P  = 0.0044, pN2: P  = 0.0194, pN3: P  = 0.0054). Patients with LV invasion were also more likely to have systemic, and any recurrence than those without LV invasion in each pN stage. Pathological nodal status and LV invasion were the most important predictors of survival and systemic recurrence in patients with esophageal cancer who underwent neoadjuvant chemotherapy followed by surgery. This finding could provide useful information about selecting candidates for adjuvant therapy among these patients. Our analysis showed that LV invasion was an independent prognostic factor in patients with esophageal cancer who underwent neoadjuvant chemotherapy and that combining LV invasion with pathological nodal status makes it possible to stratify the prognosis in those patients. [ABSTRACT FROM AUTHOR]

Objectives: The presence of lymphovascular invasion (LVI), perineural invasion (PNI) and extranodal extension (ENE) have shown adverse outcomes in oral squamous cell carcinoma (OSCC). This study evaluated the impact of LVI, PNI and ENE, individually and in combination, on survival outcomes in OSCC. Material and Methods: A retrospective analysis of a prospectively maintained oral cancer database was done from January 2017 to March 2023. All consecutive OSCC patients who underwent curative intent surgery were included. The triple-positive group was defined by the presence of all three features (LVI/PNI/ENE), while the double-positive group had the presence of two features. The disease-free survival (DFS) and overall survival (OS) analysis was done between different study groups. Results: A total of 255 patients were included in the analysis. The LVI, PNI and ENE positivity was 13%, 26% and 11%, respectively. There were 19 patients (7%) with double-positive and ten patients (4%) with triple-positive disease. The triple-positive group had lower DFS than non-triple-positive (0% vs 57%, p-value 0.001) and lower OS (0% vs 72%, p-value 0.003). The median DFS and OS of the triple-positive group were eight months and 24 months, respectively. Similarly, the double-positive group also had statistically significant inferior DFS (p-value 0.007) and OS (p-value 0.002) compared to the single-positive/triple-negative group. Conclusion: The triple-positive disease had poor outcomes, with no patients achieving disease-free or overall survival at the 5-year follow-up. The presence of multiple adverse factors necessitates modification of adjuvant therapy and therapeutic strategy, which may enhance survival outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To select patients who would benefit most from sentinel lymph node biopsy (SLNB) by investigating the characteristics and risk factors of axillary lymph node metastasis (ALNM) in microinvasive breast cancer (MIBC). Methods: This retrospective study included 1688 patients with MIBC who underwent breast surgery with axillary staging at the Asan Medical Center from 1995 to 2020. Results: Most patients underwent SLNB alone (83.5%). Seventy (4.1%) patients were node-positive, and the majority had positive lymph nodes < 10 mm, with micro-metastases occurring frequently (n = 37; 55%). Node-positive patients underwent total mastectomy and axillary lymph node dissection (ALND) more than breast-conserving surgery (BCS) and SLNB compared with node-negative patients (p < 0.001). In the multivariate analysis, independent predictors of ALNM included young age [odds ratio (OR) 0.959; 95% confidence interval (CI) 0.927–0.993; p = 0.019], ALND (OR 11.486; 95% CI 5.767–22.877; p < 0.001), number of lymph nodes harvested (≥ 5) (OR 3.184; 95% CI 1.555–6.522; p < 0.001), lymphovascular invasion (OR 6.831; 95% CI 2.386–19.557; p < 0.001), presence of multiple microinvasion foci (OR 2.771; 95% CI 1.329–5.779; p = 0.007), prominent lymph nodes in preoperative imaging (OR 2.675; 95% CI 1.362–5.253; p = 0.004), and hormone receptor positivity (OR 2.491; 95% CI 1.230–5.046; p = 0.011). Conclusion: Low ALNM rate (4.1%) suggests that routine SLNB for patients with MIBC is unnecessary but can be valuable for patients with specific risk factors. Ongoing trials for omitting SLNB in early breast cancer, and further subanalyses focusing on rare populations with MIBC are necessary. [ABSTRACT FROM AUTHOR]

To retrospectively assess the effectiveness of deep learning (DL) model, based on breast magnetic resonance imaging (MRI), in predicting preoperative lymphovascular invasion (LVI) status in patients diagnosed with invasive breast cancer who have negative axillary lymph nodes (LNs). Data was gathered from 280 patients, including 148 with LVI-positive and 141 with LVI-negative lesions. These patients had undergone preoperative breast MRI and were histopathologically confirmed to have invasive breast cancer without axillary LN metastasis. The cohort was randomly split into training and validation groups in a 7:3 ratio. Radiomics features for each lesion were extracted from the first post-contrast dynamic contrast-enhanced (DCE)-MRI. The Least Absolute Shrinkage and Selection Operator (LASSO) regression method and logistic regression analyses were employed to identify significant radiomic features and clinicoradiological variables. These models were established using four machine learning (ML) algorithms and one DL algorithm. The predictive performance of the models (radiomics, clinicoradiological, and combination) was assessed through discrimination and compared using the DeLong test. Four clinicoradiological parameters and 10 radiomic features were selected by LASSO for model development. The Multilayer Perceptron (MLP) model, constructed using both radiomic and clinicoradiological features, demonstrated excellent performance in predicting LVI, achieving a high area under the curve (AUC) of 0.835 for validation. The DL model (MLP-radiomic) achieved the highest accuracy (AUC = 0.896), followed by DL model (MLP-combination) with an AUC of 0.835. Both DL models were significantly superior to the ML model (RF-clinical) with an AUC of 0.720. The DL model (MLP), which integrates radiomic features with clinicoradiological information, effectively aids in the preoperative determination of LVI status in patients with invasive breast cancer and negative axillary LNs. This is beneficial for making informed clinical decisions. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prognostic significance of lymphovascular invasion in invasive breast cancer and the value of using specific vascular endothelial markers to further classify lymphovascular invasion. Methods: We collected 2124 patients with invasive breast cancer who were hospitalized at the First Hospital of Dalian Medical University from 2012 to 2020. Statistical methods were used to investigate the relationship between lymphovascular invasion and clinicopathological characteristics of breast cancer, and the correlation between lymphovascular invasion on overall survival (OS) and disease-free survival (DFS) of various categories of breast cancers. Immunohistochemical staining of breast cancer samples containing lymphovascular invasion using specific vascular endothelial markers D2-40 and CD34 was used to classify lymphovascular invasion and to investigate the relationship between lymphovascular invasion and breast cancer progression. Results: There was a high correlation between lymphovascular invasion and T stage, N stage and nerve invasion. Survival analyses showed that patients with lymphovascular invasion, especially luminal B, triple-negative, and Her-2 overexpression breast cancer patients, had poorer OS and DFS prognosis, and that lymphovascular invasion was an independent prognostic factor affecting OS and DFS in breast cancer. The immunohistochemical staining results showed that positive D2-40 staining of lymphovascular invasion was linked to the N stage and localized recurrence of breast cancer. Conclusion: Lymphovascular invasion is associated with aggressive clinicopathological features and is an independent poor prognostic factor in invasive breast cancer. Breast cancer localized recurrence rate and lymph node metastases are influenced by lymphatic vessel invasion. Immunohistochemical techniques should be added to the routine diagnosis of lymphovascular invasion. [ABSTRACT FROM AUTHOR]

Simple Summary: Current clinical practice guidelines support additional locoregional surgery after local resection of early colorectal cancer when one or more of the following risk factors are present: poor differentiation grade, lymphovascular invasion, deep submucosal invasion, moderate or high tumor budding, and deep margin involvement. The absence of all these risk criteria selects a subgroup of patients with very good prognosis that can safely avoid additional surgery. However, lymph node metastases are only identified in 10–20% of patients who ultimately undergo additional surgery, so that 80–90% of the surgeries turn out to be unnecessary. In this investigation, we find that indicating additional surgery in early colorectal cancer only when either moderate or high tumor budding, poorly differentiated clusters, or lymphovascular invasion are present could reduce unnecessary surgeries by 40–45% without significantly increasing the proportion of patients with lymph node metastases who are not offered additional surgery. Background: The low positive predictive value for lymph node metastases (LNM) of common practice risk criteria (CPRC) in T1 colorectal carcinoma (CRC) leads to manyunnecessary additional surgeries following local resection. This study aimed to identify criteria that may improve on the CPRC. Methods: Logistic regression analysis was performed to determine the association of diverse variables with LNM or 'poor outcome' (LNM and/or distant metastases and/or recurrence) in a single center T1 CRC cohort. The diagnostic capacity of the set of variables obtained was compared with that of the CPRC. Results: The study comprised 161 cases. Poorly differentiated clusters (PDC) and tumor budding grade > 1 (TB > 1) were the only independent variables associated with LNM. The area under the curve (AUC) for these criteria was 0.808 (CI 95% 0.717–0.880) compared to 0.582 (CI 95% 0.479–0.680) for CPRC. TB > 1 and lymphovascular invasion (LVI) were independently associated with 'poor outcome', with an AUC of 0.801 (CI 95% 0.731–0.859), while the AUC for CPRC was 0.691 (CI 95% 0.603–0.752). TB > 1, combined either with PDC or LVI, would reduce false positives between 41.5% and 45% without significantly increasing false negatives. Conclusions: Indicating additional surgery in T1 CRC only when either TB > 1, PDC, or LVI are present could reduce unnecessary surgeries significantly. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Differentiated thyroid cancer (DTC) is the most common pediatric endocrine cancer but studies are scarce. Latest recommendations advocate for an individualized risk-based approach to select patients for additional therapy. Lymphovascular invasion is not considered, despite being a well-known risk factor in the adult population. The aim of this study was to describe the outcomes of a cohort of DTC patients diagnosed at pediatric age and to evaluate the impact of lymphovascular invasion on the risk of persistence/recurrence. METHODS: A retrospective study of patients diagnosed with DTC at pediatric age from 2010 to 2022 at a single center was performed. All patients had total thyroidectomy. Radioactive iodine therapy (RAI) was used in selected patients. The response to therapy and occurrence of persistent/recurrent disease were evaluated. RESULTS: A total of 21 DTC were diagnosed, mostly papillary thyroid carcinoma (PTC) (81.0%, n=17). Six patients (28.6%) had nodal involvement and one (4.8%) had lung metastasis at the time of the diagnosis. Lymphovascular invasion was present in 11 patients (52.4%). After surgery, 13 patients (61.9%) underwent RAI. The mean follow-up time was 5.7±3.1 years. In total, 6 patients (31.6%) experienced persistent/recurrent disease during the follow-up time. Among PTC patients, persistent/recurrent disease was more frequent in the presence of lymphovascular invasion [55.6% (5/9) vs. 0.0% (0/6), p=0.031]. DISCUSSION AND CONCLUSION: An individualized risk-based approach is recommended. Our study suggests that lymphovascular invasion may be associated with a higher risk of persistence/recurrence and should therefore be considered for decision making in children and adolescents with PTC.

Abstract To retrospectively assess the effectiveness of deep learning (DL) model, based on breast magnetic resonance imaging (MRI), in predicting preoperative lymphovascular invasion (LVI) status in patients diagnosed with invasive breast cancer who have negative axillary lymph nodes (LNs). Data was gathered from 280 patients, including 148 with LVI-positive and 141 with LVI-negative lesions. These patients had undergone preoperative breast MRI and were histopathologically confirmed to have invasive breast cancer without axillary LN metastasis. The cohort was randomly split into training and validation groups in a 7:3 ratio. Radiomics features for each lesion were extracted from the first post-contrast dynamic contrast-enhanced (DCE)-MRI. The Least Absolute Shrinkage and Selection Operator (LASSO) regression method and logistic regression analyses were employed to identify significant radiomic features and clinicoradiological variables. These models were established using four machine learning (ML) algorithms and one DL algorithm. The predictive performance of the models (radiomics, clinicoradiological, and combination) was assessed through discrimination and compared using the DeLong test. Four clinicoradiological parameters and 10 radiomic features were selected by LASSO for model development. The Multilayer Perceptron (MLP) model, constructed using both radiomic and clinicoradiological features, demonstrated excellent performance in predicting LVI, achieving a high area under the curve (AUC) of 0.835 for validation. The DL model (MLP-radiomic) achieved the highest accuracy (AUC = 0.896), followed by DL model (MLP-combination) with an AUC of 0.835. Both DL models were significantly superior to the ML model (RF-clinical) with an AUC of 0.720. The DL model (MLP), which integrates radiomic features with clinicoradiological information, effectively aids in the preoperative determination of LVI status in patients with invasive breast cancer and negative axillary LNs. This is beneficial for making informed clinical decisions.

Background: To assess the distribution characteristics of immune infiltration and lymphovascular invasion in breast cancer skin recurrence patients. Methods: We retrospectively analyzed the clinicopathological data of patients who underwent radical surgery for primary breast cancer and experienced skin recurrence between January 2001 and April 2019. Immune and lymphovascular biomarkers were quantified in primary breast cancers, skin lesions and visceral metastatic lesions. Differences in biomarkers distribution between matched tissues were statistically analyzed using the Wilcoxon signed-rank test and Kruskal–Wallis one-way ANOVA. Results: A total of 71 female breast cancer patients were reviewed in this study. Our study found that the expression levels of various lymphocyte immune markers in primary tumor specimens were higher than those in skin recurrences. The expression of CD8, CD57 and CD31 in primary breast cancer was higher than those in the skin. Compared to visceral metastatic lesions, D2-40 was highly expressed in the skin, while CD8 tended to decrease. In the skin specimens, the expression of CD8 (P < 0.001), FOXP3 (P = 0.006) and CD68 (P < 0.001) in the intratumoral area was higher, while the expression of CD57 (P < 0.001) was higher in the peritumoral area. Analyzing specimens from the same patient at different time points of skin progression, it was found that the expression of peritumoral CD4 decreased (P = 0.044) as the disease progressed. The low expression of D2-40 and CD163 in the skin lesions suggested a decrease in DFS. Conclusion: The immune microenvironment of breast cancer skin recurrence may be in a state of suppression, and this suppression may intensify with disease progression. The pattern of skin recurrence may be more inclined toward lymphatic invasion. Our study provides new insights into the biological behaviors of this disease and its response to immunotherapy. [ABSTRACT FROM AUTHOR]

To develop and validate a nomogram for quantitively predicting lymphovascular invasion (LVI) of breast cancer (BC) based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) radiomics and morphological features. We retrospectively divided 238 patients with BC into training and validation cohorts. Radiomic features from DCE-MRI were subdivided into A1 and A2, representing the first and second post-contrast images respectively. We utilized the minimal redundancy maximal relevance filter to extract radiomic features, then we employed the least absolute shrinkage and selection operator regression to screen these features and calculate individualized radiomics score (Rad score). Through the application of multivariate logistic regression, we built a prediction nomogram that integrated DCE-MRI radiomics and MR morphological features (MR-MF). The diagnostic capabilities were evaluated by comparing C-indices and calibration curves. The diagnostic efficiency of the A1/A2 radiomics model surpassed that of the A1 and A2 alone. Furthermore, we incorporated the MR-MF (diffusion-weighted imaging rim sign, peritumoral edema) and optimized Radiomics into a hybrid nomogram. The C-indices for the training and validation cohorts were 0.868 (95% CI: 0.839–0.898) and 0.847 (95% CI: 0.787–0.907), respectively, indicating a good level of discrimination. Moreover, the calibration plots demonstrated excellent agreement in the training and validation cohorts, confirming the effectiveness of the calibration. This nomogram combined MR-MF and A1/A2 Radiomics has the potential to preoperatively predict LVI in patients with BC. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to investigate preoperative predictors of lymphovascular invasion (LVI), which is a poor prognostic factor usually detected postoperatively in patients with colorectal cancer. Methods Results for all patients operated on for colorectal cancer between January 1, 2006, and December 31, 2021, were retrospectively analyzed. Potential preoperative factors and postoperative pathology results were recorded. The patients were categorized as those with LVI and those without LVI. Potential factors that may be associated with LVI were compared between the 2 groups. Results The study included 335 patients. The incidence of LVI was 3.11 times higher in patients with ascending colon tumors (odds ratio [OR], 3.11; 95% confidence interval [CI], 1.34–7.23; P=0.008) and 4.28 times higher in those with metastatic tumors (OR, 4.28; 95% CI, 2.18–8.39; P

Kun Wang,1 Wei Zhu,2 Wei Huang,3 Kangkang Huang,1 Huidan Luo,1 Lu Long,1 Bin Yi1 1Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China; 2Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China; 3Research Center of Carcinogenesis and Targeted Therapy, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of ChinaCorrespondence: Bin Yi, Tel +86-13707495781, Email xyyibin@163.comObjective: Ubiquitination is an important post-translational modification. However, the significance of the TRIM family of E3 ubiquitin ligases in head and neck squamous cell carcinoma (HNSCC) has not been determined. In this study, the roles of TRIM E3 ubiquitin ligases in lymphovascular invasion in head and neck squamous cell carcinoma (HNSCC) were evaluated.Materials and Methods: TRIM expression and related parameters were obtained from UbiBrowser2.0, UALCAN, TIMER, TISIDB, LinkedOmics, STRING, and GeneMANIA databases. Immunohistochemistry was used to confirm their expression.Results: TRIM2, TRIM11, TRIM28, and TRIM56 were upregulated in HNSCC with lymphovascular invasion. TRIM expression was strongly associated with immune infiltration, including key treatment targets, like PD-1 and CTL4. Co-expressed genes and possible ubiquitination substrates included tumor-related factors. The TRIMs had predicted roles in ubiquitination-related pathways and vital signaling pathways, eg, MAPK, PI3K-Akt, and JAK-STAT signaling pathways.Conclusion: Ubiquitination mediated by four TRIMs might be involved in the regulation of tumor immunity, laying the foundation for future studies of the roles of the TRIM family on the prediction and personalized medicine in HNSCC. The four TRIMs might exert oncogenic effects by promoting lymphovascular invasion in HNSCC.Keywords: ubiquitination, TRIM, head and neck squamous cell carcinoma, bioinformatic analysis, lymphovascular invasion

Introduction and AimTumor budding is a distinctive phenomenon which involves the presence of small clusters or individual cancer cells at the invasive front of tumors. Tumor budding has garnered attention due to its potential implications for prognosis, treatment strategies, and our understanding of cancer progression. Our aim is to study the distribution of tumor buds and its scoring in patients with infiltrating breast carcinoma and to associate with other histopathological parameters like the size of the tumor, its grade, lymphovascular invasion, and lymph node metastasis. Materials and MethodsThis was a study analyzing the data of 70 resected specimens of primary breast carcinomas and providing a descriptive overview. Tumor budding was recognized, counted, and graded in hematoxylin and eosin slides. The cases were classified as low (0–4), intermediate (5–9), and high (≥10 buds) based on the count of tumor buds. Tumor budding has significant correlation with tumor grade and tumor size. ResultsOf the 70 cases, 60 cases (85.71%) were diagnosed as invasive ductal carcinoma NOS. The majority [38 (54.28%)] of the cases showed an intermediate tumor budding score of 5–9/10 HPF. ConclusionEvaluation of tumor budding allows pathologists and oncologists to gather valuable information about the tumor’s biological aggressiveness and potential for metastasis. It also helps in better risk stratification of patients, enabling a more personalized and tailored approach to treatment planning. In conclusion, assessing tumor budding in breast carcinoma holds significant clinical importance in the management and prognosis of this disease.

Abstract Background Lymphovascular invasion (LVI) is a poor prognostic factor in various malignancies. However, its prognostic effect in remnant gastric cancer (RGC) remains unclear. We examined the correlation between LVI and disease prognosis in patients with T1N0-3 or T2-3N0 RGC in whom adjuvant chemotherapy was not indicated and a treatment strategy was not established. Methods We retrospectively analyzed patients with T1N0-3 and T2-3N0 RGC who underwent curative surgery at the Kyoto Prefectural University of Medicine between 1997 and 2019 and at the Kyoto Chubu Medical Center between 2009 and 2019. Results Fifteen of 38 patients (39.5%) with RGC were positive for LVI. Patients with LVI had a significantly poorer prognosis for both overall survival ([OS]: P = 0.006) and recurrence-free survival ([RFS]: P = 0.001) than those without LVI. Multivariate analyses using the Cox proportional hazards model revealed LVI as an independent prognostic factor affecting OS (P = 0.024; hazard ratio 8.27, 95% confidence interval:1.285–161.6) and RFS (P = 0.013; hazard ratio 8.98, 95% confidence interval:1.513–171.2). Conclusions LVI is a prognostic factor for patients with T1N0-3 or T2-3N0 RGC. Evaluating LVI may be useful for determining treatment strategies for RGC.

This study intended to investigate the feasibility and effectiveness of using clinical magnetic resonance imaging (MRI) radiomics features to predict lymphovascular invasion (LVI) status in breast cancer (BC) patients. A total of 182 BC patients were retrospectively collected and randomly divided into a training set (n = 127) and a validation set (n = 55) in a 7:3 ratio. Based on pathological examination results, the training set was further divided into LVI group (n = 60) and non-LVI group (n = 67), and the validation set was divided into LVI group (n = 24) and non-LVI group (n = 31). General data and MRI examination indicators were compared. Multivariate logistic regression was utilized to analyze MRI radiomics features and clinically relevant indicators that were significant in the baseline information of patients in training set, independent risk factors were identified, and a logistic regression model was built. The accuracy of logistic model was validated using ROC curves in training and validation sets. Age, pathohistological classification, tumor length, tumor width, presence or absence of Magnetic Resonance Spectroscopy (MRS) cho peak, presence or absence of spicule sign, peritumoral enhancement, and peritumoral edema were statistically significant (P < 0.05) between the two groups. Multivariate logistic regression analysis presented that spicule and peritumoral edema were independent risk factors for LVI in BC patients (P < 0.05). The ROC curve illustrated that AUC of the logistic regression model in the training set was 0.807 (95%CI: 0.730–0.885) and that in the validation set was 0.837 (95%CI: 0.731–0.944). Radiomics features of spicule sign and peritumoral edema were independent risk factors for LVI in BC patients. A logistic regression model based on these factors, along with age, could accurately predict LVI occurrence in BC patients, providing data support for diagnosis and modeling of LVI in BC patients. [ABSTRACT FROM AUTHOR]

Endometrial cancer is a disease that is still among the top ten causes of mortality and morbidity in Ukraine today. More and more new data about this malignant neoplasm appear every day, which forces us to revise the approaches in the diagnosis and treatment of it. In June 2023, the International Federation of Gynecology and Obstetrics (FIGO) published the staging of endometrial cancer, which included new data obtained in recent years in the process of studying this pathology. It is important to note that the new review is significantly different from the previous one, because it is based not only on the anatomical spread of the tumor, but also on histological characteristics: lymphovascular invasion and its spread, differentiation and histological type of the tumor, invasion into the myometrium. Molecular classification was implemented, taking into account the new WHO edition of histological forms of tumors of the female reproductive system in 2020. The 2023 FIGO staging calls attention to the important role of the histologist in deciding the stage of endometrial cancer. This is one of the challenges for the gynecological oncology community, which will require a single protocol that would include the main histological aspects in the description of the tumor. It is also indicated the molecular profile of the tumor, which plays an important role in FIGO-2023 staging of endometrial cancer. Knowledge of the molecular profile of the tumor is importantly in the management of patients in the early stages of endometrial cancer, namely stages I and II. The presence or absence of certain markers of tumor aggressiveness can not only change the stage, but also lead to de-escalation of the patient’s treatment. Currently, there is a challenge of financial inaccessibility of the NGS (next generation sequencing) method, which is why this type of diagnosis is often avoided. This requires the search for new adapted algorithms for determining the molecular profile of a tumor, until the determination of POLEmut becomes more accessible to the Ukrainian community. [ABSTRACT FROM AUTHOR]

Background: Assessment of lymphovascular invasion (LVI) in breast cancer (BC) primarily relies on preoperative needle biopsy. There is an urgent need to develop a non‐invasive assessment method. Purpose: To develop an effective model to assess the LVI status in patients with BC using magnetic resonance imaging morphological features (MRI‐MF), Radiomics, and deep learning (DL) approaches based on dynamic contrast‐enhanced MRI (DCE‐MRI). Study Type: Cross‐sectional retrospective cohort study. Population: The study included 206 BC patients, with 136 in the training set [97 LVI(−) and 39 LVI(+) cases; median age: 51.5 years] and 70 in the test set [52 LVI(−) and 18 LVI(+) cases; median age: 48 years]. Field Strength/Sequence: 1.5 T/T1‐weighted images, fat‐suppressed T2‐weighted images, diffusion‐weighted imaging (DWI), and DCE‐MRI. Assessment: The MRI‐MF model was developed with conventional MR features using logistic analyses. The Radiomic feature extraction process involved collecting data from categorized DCE‐MRI datasets, specifically the first and second post‐contrast images (A1 and A2). Next, a DL model was implemented to determine LVI. Finally, we established a joint diagnosis model by combining the MRI‐MF, Radiomics, and DL approaches. Statistical Tests: Diagnostic performance was compared using receiver operating characteristic curve analysis, confusion matrix, and decision curve analysis. Results: Rim sign and peritumoral edema features were used to develop the MRI‐MF model, while six Radiomics signature from the A1 and A2 images were used for the Radiomics model. The joint model (MRI‐MF + Radiomics + DL models) achieved the highest accuracy (area under the curve [AUC] = 0.857), being significantly superior to the MRI‐MF (AUC = 0.724), Radiomics (AUC = 0.736), or DL (AUC = 0.740) model. Furthermore, it also outperformed the pairwise combination models: Radiomics + MRI‐MF (AUC = 0.796), DL + MRI‐MF (AUC = 0.796), or DL + Radiomics (AUC = 0.826). Data Conclusion: The joint model incorporating MRI‐MF, Radiomics, and DL approaches can effectively determine the LVI status in patients with BC before surgery. Level of Evidence: 4 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Introduction: Lymphovascular invasion (LVI) is a pivotal histopathological parameter in prostate cancer (PCa), holding significant prognostic implications. Our study pursued a dual objective: firstly, to identify preoperative factors associated with LVI, aiming to unveil markers facilitating the recognition of patients prone to LVI during postoperative examination; and secondly, to assess postoperative outcomes correlated with LVI. Methods: We retrospectively analyzed 861 nonmetastatic PCa patients who underwent radical prostatectomy (RP), investigating preoperative factors and postoperative outcomes. Surgical specimens were processed following established guidelines. Statistical analyses utilized non-parametric tests to assess the association between LVI and both pre- and postoperative factors. Furthermore, logistic regression analyses were utilized to develop models aimed at identifying the most significant predictors of LVI and pN1 status, respectively. Results: Numerous preoperative factors exhibited significant correlations with LVI, offering valuable clinical insights. Logistic regression identified magnetic resonance imaging (MRI)-based clinical tumor stage (cT) 3-4, biopsy Gleason Grading Group (GGG) 3-5, preoperative prostate specific antigen (PSA) ≥20 and percentage of positive biopsy cores (PPBC) ≥50% as the strongest preoperative predictors of LVI. Additionally, the study uncovered an association between LVI and postoperative outcomes, including postoperative PSA (p value <0.001), extracapsular extension (ECE) (<0.001), positive surgical margins (PSM) (<0.001), perineural invasion (PNI) (<0.001), pathological tumor stage (pT) (<0.001), pathological lymph node status (pN) (<0.001), postoperative GGG (<0.001), and operative time (0.023). Notably, the study revealed a novel and substantial association between LVI and an increased number of positive lymph nodes in pN+ patients in the univariate analysis (<0.001). Furthermore, we have found an association between LVI and pN1 status in the logistic regression analysis (odds ratio [OR] = 23.905; p <0.001). Conclusion: Our findings underscore the pivotal role of LVI in influencing the prognosis of prostate cancer (PCa). The study acknowledges the challenges associated with preoperative LVI assessment and emphasizes the need for future research to unravel the factors associated with this histopathological finding. Significantly, our research stands out as the first, to the best of our knowledge, to reveal the association between LVI and the number of positive lymph nodes in pN+ patients. [ABSTRACT FROM AUTHOR]

Background: Very well-differentiated gastric adenocarcinoma (VWDA) is a rare variant of gastric cancer, for which the diagnostic criteria and clinical behavior are not fully established. We reported a case of an intramucosal VWDA of gastric type with a lymphovascular invasion (LVI). Case presentation: A 67-year-old female was diagnosed as intramucosal gastric adenocarcinoma after a biopsy at the local hospital 3 weeks ago and then visited our hospital for further treatment. The endoscopic examination in our hospital showed a rough, slightly faded, 30-mm, flat, and elevated lesion on the lesser curvature of the middle gastric body. Histopathologically, the lesion consisted of superficial foveolar-type papillary adenocarcinoma and deep pyloric gland-type tubular adenocarcinoma. The immunostaining results showed that the foveolar-type papillary adenocarcinoma was positive for MUC5AC and had a high index of Ki-67, but the pyloric gland-type tubular adenocarcinoma was positive for MUC6 and had a low index of Ki-67. Both components were negative for MSH2 and MSH6, which suggested the high microsatellite instability phenotype. Moreover, a LVI was detected in the lesion. The pathological diagnosis was VWDA of gastric type. Conclusion: The case has unique histological and immunophenotypic characteristics, which not only indicates the importance of architectural features in the diagnosis of VWDA but also further proves that the aggressive behavior of VWDA is correlated with tumor histological type and immunophenotype. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prognostic ability of lymphovascular invasion (LVI) in upper tract urothelial carcinoma (UTUC) as a predictor of overall survival (OS) using a large North American cohort. Patients and Methods: Our cohort included 5940 patients with clinical M0 UTUC who underwent a radical nephroureterectomy (RNU), between 2010 and 2016, within the National Cancer Database. The main variable of interest was LVI status, and its interaction with pathological nodal (pN) status. Kaplan–Meier curves were used to depict the OS also stratifying patients on LVI status. Cox regression analysis tested the impact of LVI status on OS after accounting for the available covariates. Results: The median (interquartile range [IQR]) age at diagnosis was 71 (63–78) years and most patients had pathological T1 stage disease (48.6%). Nodal status was pN0, pN1 and pNx in 45.8%, 6.3% and 47.9%, respectively. Overall, 22.1% had LVI. The median (IQR) follow‐up time was 32.6 (16.0–53.3) months. At the 5‐year postoperative follow‐up, the estimated OS rate was 28% in patients with LVI vs 66% in those without LVI (P < 0.001). When patients were stratified based on nodal status those rates were 32% vs 68% in pN0 patients (P < 0.001), 23% vs 30% in pN1 patients (P = 0.8), and 28% vs 65% in pNx patients (P < 0.001). On multivariable analysis, the presence of LVI was associated with less favourable OS (hazard ratio 1.79, 95% confidence interval 1.60–1.99; P < 0.001). Conclusion: Our study assessed the impact of LVI on OS in patients with UTUC in a large North American nationwide cohort. Our series, as the largest to date, indicate that LVI is associated with less favourable survival outcomes in patients with UTUC after RNU, and this variable could be used in counselling patients about their prognosis and might be a useful tool for future trials to risk‐stratify patients. [ABSTRACT FROM AUTHOR]

Treatment strategies for invasive breast cancer require accurate lymphovascular invasion (LVI) predictions. This study aimed to investigate the effectiveness of delta radiomics based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for assessing LVI and develop a nomogram to aid treatment decisions. Overall, 293 patients with resectable invasive breast cancer underwent preoperative DCE-MRI. Radiomic features were extracted from pre-contrast (A0), first post-contrast (A1), and subtracted images of A0 and A1. Three radiomics models were developed using several data analyses; logistic analyses were performed to identify radiological features to predict the LVI status. A hybrid model integrating both radiological features and optimal radiomics was developed. Receiver operating characteristic analysis was employed to evaluate model performance, using the area under the curve (AUC) as a quantitative metric for discriminative ability. In the test set, the Radiomics-Delta model, with 17 radiomic features, had an AUC of 0.781 and accuracy of 0.705. Radiomics-A0, with 10 features, had an AUC of 0.619 and accuracy of 0.523, while Radiomics-A1, with 8 features, had an AUC of 0.715 and accuracy of 0.591. The hybrid model exhibited better performance, with an AUC of 0.868 and accuracy of 0.875, than the radiological and Radiomics-Delta models, with an AUC of 0.759 and 0.781, respectively, and accuracy of 0.773 and 0.705, respectively. Compared to Radiomics-A0 and Radiomics-A1, Radiomics-Delta demonstrated superior performance. Moreover, the hybrid model incorporating Radiomics-Delta and radiological features exhibited excellent performance in determining the LVI status in cases of invasive breast cancer. [ABSTRACT FROM AUTHOR]

This study aimed to create a nomogram model that combines clinical factors with radiomics analysis of both intra- and peritumoral regions extracted from preoperative digital breast tomosynthesis (DBT) images, in order to develop a reliable method for predicting the lymphovascular invasion (LVI) status in invasive breast cancer (IBC) patients. A total of 178 patients were randomly split into a training dataset (N = 124) and a validation dataset (N = 54). Comprehensive clinical data, encompassing DBT features, were gathered for all cases. Radiomics features were extracted and selected from intra- and peritumoral region to establish radiomics signature (Radscore). To construct the clinical model and nomogram model, univariate and multivariate logistic regression analyses were utilized to identify independent risk factors. To assess and validate these models, various analytical methods were employed, including receiver operating characteristic (ROC) curve analysis, calibration curve analysis, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discriminatory improvement (IDI). The clinical model is constructed based on two independent risk factors: tumor margin and the DBT-reported lymph node metastasis (DBT_reported_LNM). Incorporating Radscore_Combine (utilizing both intra- and peritumoral radiomics features), tumor margin, and DBT_reported_LNM into the nomogram achieved a reliable predictive performance, with area under the curve (AUC) values of 0.906 and 0.905 in both datasets, respectively. The significant improvement demonstrated by the NRI and IDI indicates that the Radscore_Combine could be a valuable biomarker for effectively predicting the status of LVI. The nomogram demonstrated a reliable ability to predict LVI in IBC patients. [ABSTRACT FROM AUTHOR]

Background: Postoperative radiotherapy radiation therapy (PORT) for early‐stage human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) with positive lymphovascular invasion (LVI) has an unclear association with overall survival (OS). Methods: This retrospective cohort study queried the National Cancer Database for surgically treated, T1‐2, N0‐1 HPV+ OPSCC from 2010 to 2019. Primary exposures were LVI and PORT, and the main outcome was 5‐year OS. Odds ratios and hazard ratios (HR) with 95% confidence intervals (CIs) were generated using multivariable models and Cox proportional hazard models, respectively. Results: Of 2768 patients, average age was 59.3 years, 2207 (79.7%) were male, and 386 (13.9%) had LVI. Of patients with LVI as their sole adverse pathologic feature, 220 (57.0%) received PORT, which was not associated with 5‐year OS (HR, 1.13; CI, 0.65–1.19). Conclusions: Patients with surgically treated, early‐stage HPV+ OPSCC and positive LVI as their only pathologic adverse feature may not require PORT. [ABSTRACT FROM AUTHOR]

Objective To explore the value of apparent diffusion coefficient(ADC)on reduced field-of-view diffusion-weighted magnetic resonance imaging(r-FOV DWI)in assessing lymphovascular invasion(LVI)of extrahepatic cholangiocarcinoma(EHCC).Methods Fifty-four patients with pathologically confirmed EHCC underwent pre-operative conventional and r-FOV DWI.Two senior radiologists evaluated the image quality using a 5-point Likert scale and measured the signal-to-noise ratios(SNR), contrast-to-noise ratios(CNR), and ADC values of the lesions on DWI.According to pathological data, patients were divided into the LVI-positive group and the LVI-negative groups.The conventional and r-FOV ADC values for demonstrating LVI were compared between the two groups using the receiver operating characteristic(ROC)curves.Results The image quality of r-FOV DWI was better with higher scores than that of conventional DWI with significantly higher subjective scores as well as lower SNR, CNR, and ADC values than that of conventional DWI(P＜0.05).Both conventional and r-FOV ADC values in the LVI-positive group were significantly lower than those in the LVI-negative group(P＜0.05).The area under the ROC curve(AUC)for diagnosing LVI using conventional ADC value＜1.217×10-3 mm²/s was 0.746(P＜0.05), with 75.0％sensitivity and 73.5％specificity.The AUC for diagnosing LVI using r-FOV ADC value＜1.092×10-3 mm²/s was 0.932(P＜0.05)with 95.0％sensitivity and 85.3％specificity.The difference in AUC values between the two groups was statistically significant(P＜0.05).Conclusion r-FOV ADC values are better than conventional ADC values for demonstrating LVI of EHCC. [ABSTRACT FROM AUTHOR]

Background: Lymphovascular invasion (LVI) is a poor prognostic factor in various malignancies. However, its prognostic effect in remnant gastric cancer (RGC) remains unclear. We examined the correlation between LVI and disease prognosis in patients with T1N0-3 or T2-3N0 RGC in whom adjuvant chemotherapy was not indicated and a treatment strategy was not established. Methods: We retrospectively analyzed patients with T1N0-3 and T2-3N0 RGC who underwent curative surgery at the Kyoto Prefectural University of Medicine between 1997 and 2019 and at the Kyoto Chubu Medical Center between 2009 and 2019. Results: Fifteen of 38 patients (39.5%) with RGC were positive for LVI. Patients with LVI had a significantly poorer prognosis for both overall survival ([OS]: P = 0.006) and recurrence-free survival ([RFS]: P = 0.001) than those without LVI. Multivariate analyses using the Cox proportional hazards model revealed LVI as an independent prognostic factor affecting OS (P = 0.024; hazard ratio 8.27, 95% confidence interval:1.285–161.6) and RFS (P = 0.013; hazard ratio 8.98, 95% confidence interval:1.513–171.2). Conclusions: LVI is a prognostic factor for patients with T1N0-3 or T2-3N0 RGC. Evaluating LVI may be useful for determining treatment strategies for RGC. [ABSTRACT FROM AUTHOR]

Background: Several prognostic factors for primary cutaneous melanoma (PCM) have been identified, and these predict metastasis and survival, to a certain extent. We sought to determine the frequency of angiotropism (AT) and lymphovascular invasion (LVI) in PCM and the relationship between AT, LVI, and other clinicopathological parameters and patient's prognosis. Methods: This study included 538 cases of PCM diagnosed between 2003 and 2016. It comprised 246 females and 292 males whose clinicopathological variables were evaluated with respect to LVI and AT using univariate and multivariate analyses. Overall survival (OS) was assessed by Kaplan–Meier (KM) analysis and Cox regression multivariate analysis. Results: AT occurred more frequently than LVI. Ulceration, mitotic rate, and Breslow thickness were found to be highly associated with both LVI and AT (p < 0.01). All LVI+ cases had AT, with a significant positive correlation (p < 0.01). Both AT and LVI predicted lymph node (LN) metastasis (odds ratio [OR] = 1.47, 1.12, respectively). Multivariate analysis showed LN metastasis, Breslow thickness, LVI, and AT as predictors of OS. LVI and AT independently predicted adverse OS by Cox regression analysis (hazard ratio [HR] = 1.66, 1.49, respectively) and with KM survival analysis. Conclusion: AT is a marker for angiotropic extravascular migratory tumor spread (angiotropic EVMM), and LVI is a marker for intra‐lymphovascular tumor spread. Both predict poor prognosis. Given its ease of detection, AT could be adopted as a histologpathological feature in the routine assessment of primary cutaneous malignant melanoma cases. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Endoscopic eradication therapy (EET) is standard of care for T1a esophageal adenocarcinoma (EAC). However, data on outcomes in high-risk T1a EAC are limited. We assessed and compared outcomes after EET of low-risk and high-risk T1a EAC, including intraluminal EAC recurrence, extraesophageal metastases, and overall survival. METHODS: Patients who underwent EET for T1a EAC at 3 referral Barrett's esophagus endotherapy units between 1996 and 2022 were included. Patients with submucosal invasion, positive deep margins, or metastases at initial diagnosis were excluded. High-risk T1a EAC was defined as T1a EAC with poor differentiation and/or lymphovascular invasion, with low-risk disease being defined without these features. All pathology was systematically assessed by expert gastrointestinal pathologists. Baseline and follow-up endoscopy and pathology data were abstracted. Time-to-event analyses were performed to compare outcomes between groups. RESULTS: One hundred eighty-eight patients with T1a EAC were included (high risk, n 5 45; low risk, n 5 143) with a median age of 70 years, and 84% were men. Groups were comparable for age, sex, Barrett's esophagus length, lesion size, and EET technique. Rates of delayed extraesophageal metastases (11.1% vs 1.4%) were significantly higher in the high-risk group (P 5 0.02). There was no significant difference in the rates of intraluminal EAC recurrence (P 5 0.79) and overall survival (P 5 0.73) between the 2 groups. DISCUSSION: Patients with high-risk T1a EAC undergoing successful EET had a substantially higher rate of extraesophageal metastases compared with those with low-risk T1a EAC on long-term follow-up. These data should be factored into discussions with patients while selecting treatment approaches. Additional prospective data in this area are critical. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cancer is the fifth most common cancer today. It is the third most common cause of cancer-related death because it is usually at an advanced stage at the time of diagnosis. Several factors affect the prognosis of gastric cancer. In this study, we examined various factors affecting the prognosis in gastric cancer and evaluated their effects on the prognosis. Methods: Between 2011 and 2016, 146 patients who underwent resection with the diagnosis of curative gastric cancer in Haydarpaşa Numune Training and Research Hospital General Surgery Clinic were included in the study. A total of 146 gastric cancer patients who underwent curative surgery were retrospectively analyzed. Age, gender, type of operation, preoperative albumin and tumor markers, tumor stage, lymph node involvement, histological type, tumor localization, tumor differentiation, lymphovascular and perineural invasion, and Her-2 immunohistochemical features were examined, and survival analyses were performed. Results: Age, stage, lymph node involvement, and perineural-lymphovascular invasion were found to be statistically significant. Discussion and Conclusion: It was concluded that the determination of these prognostic factors will have an important place in the planning of the treatment. However, the subject should be supported by randomized clinical studies involving more patients. [ABSTRACT FROM AUTHOR]

Background: Breast cancer subtypes, distinguished by hormone receptor (HR) and HER2 status, have different clinicopathologic features. With recognition of the clinical relevance of HER2-low, there is debate as to whether this is a distinct subtype. Our study aimed to determine whether HER2-low breast cancers have specific clinicopathologic features that differ from those of HER2-negative and HER2-positive cancers. Patients and Methods: A total of 11,072 patients undergoing upfront surgery from 1998 to 2010 were identified from a single-institution prospectively maintained database. HER2 status was classified by immunohistochemistry (IHC)/fluorescence in situ hybridization (FISH) as HER2 negative (41.2%), HER2 low (45%; IHC 1+ or 2+ with negative FISH), and HER2 positive (13.7%), and stratified by HR status. Univariate (UVA) and multivariable multinomial logistic regression analysis (MVA) were performed to determine associations among variables and subtypes. Results: Compared with HER2-negative tumors, HER2 low was associated with lymphovascular invasion [odds ratio (OR) 1.2, 95% confidence interval (CI) 1.06–1.36; p = 0.003], multifocality (OR 1.26, 95% CI 1.12–1.42; p < 0.001), nodal micrometastasis (OR 1.15, 95% CI 1.02–1.31; p = 0.024), and lower rates of ≥ 3 positive nodes (OR 0.77, 95% CI 0.66–0.90, p = 0.001). When stratified by HR expression, in both HR-positive and HR-negative tumors, age and multifocality were associated with HER2 low on UVA. On MVA, no variables were independently associated with both HR-negative and HR-positive/HER2-low tumors compared with HER2-negative tumors. In contrast, HER2-positive tumors, regardless of HR status, were associated with multifocality and an extensive intraductal component. Conclusion: Clinicopathologic features of HER2-low tumors appear to be primarily related to HR status. Our findings do not support the characterization of HER2 low as a separate subtype. [ABSTRACT FROM AUTHOR]

Background: Forkhead box C2 gene (FOXC2) acts as an epithelial-mesenchymal transition (EMT) inducer while Prospero homeobox 1 gene (PROX-1) function as a regulator of lymphangiogenesis and angiogenesis in oral squamous cell carcinoma (OSCC). It is presumed that PROX-1 has both tumour-suppressive and oncogenic effects. The main aim of this study is to evaluate the role of PROX-1 and FOXC2 in the invasion and progression of OSCC cases and to correlate their expression with various histopathological parameters. Materials and Methods: A prospective cohort study was conducted in a total sample size of 52 OSCC tissues and histologically tumour-free margins of 20. mRNA expression and protein levels of FOXC2 and PROX-1 were evaluated using real-time PCR and sandwich enzyme-linked immunosorbent assay techniques. Chi-square analysis and correlation analysis were done. Kaplan-Meier analysis evaluated the survival rate. Results: Mean Ct values of FOXC2 were 1.915 ± 0.519 and PROX-1 was 0.061 ± 0.173. There was a significant 2-fold increase in the FOXC2 expression and a 0.5-fold decrease in the PROX-1 expression in OSCC tissue. Increased levels of FOXC2 protein and decreased levels of PROX-1 with a mean difference of 1.64 ± 0.73 ng/ml and 1.27 ± 0.33 ng/ml were observed in OSCC compared to histologically tumour-free margins. A significant positive correlation was found between the FOXC2 expression and clinicopathological parameters such as staging, perineural invasion (PNI) and lymphovascular invasion (LVI) whereas PROX-1 showed a significant negative correlation with histopathological parameters such as staging, PNI, LVI and tumour staging. There was a significant positive correlation between the PROX-1 and histologically tumour-free margins in disease-free survival patients (P-value = 0.03). Conclusion: FOXC2 and PROX-1 expressions were correlated with lymphovascular invasion, OSCC tumour staging and PNI. Thus, FOXC2 and PROX-1 could be possible therapeutic targets in the treatment of OSCC that can inhibit the EMT in OSCC and thereby favouring a better prognosis. [ABSTRACT FROM AUTHOR]

BackgroundLymphovascular invasion (LVI) is a significant risk factor for lymph node metastasis in gastric cancer (GC) and is closely related to the prognosis and recurrence of GC. This study aimed to establish clinical models, radiomics models and combination models for the diagnosis of GC vascular invasion.MethodsThis study enrolled 146 patients with GC proved by pathology and who underwent radical resection of GC. The patients were assigned to the training and validation cohorts. A total of 1,702 radiomic features were extracted from contrast-enhanced computed tomography images of GC. Logistic regression analyses were performed to establish a clinical model, a radiomics model and a combined model. The performance of the predictive models was measured by the receiver operating characteristic (ROC) curve.ResultsIn the training cohort, the age of LVI negative (−) patients and LVI positive (+) patients were 62.41 ± 8.41 and 63.76 ± 10.08 years, respectively, and there were more male (n = 63) than female (n = 19) patients in the LVI (+) group. Diameter and differentiation were the independent risk factors for determining LVI (−) and (+). A combined model was found to be relatively highly discriminative based on the area under the ROC curve for both the training (0.853, 95% CI: 0.784–0.920, sensitivity: 0.650 and specificity: 0.907) and the validation cohorts (0.742, 95% CI: 0.559–0.925, sensitivity: 0.736 and specificity: 0.700).ConclusionsThe combined model had the highest diagnostic effectiveness, and the nomogram established by this model had good performance. It can provide a reliable prediction method for individual treatment of LVI in GC before surgery.

Spermatocytic tumors are rare testicular cancers, accounting for less than 1 % of all testicular neoplasms, usually affecting older men. This report details a 35-year-old male with a spermatocytic tumor featuring extensive lymphovascular invasion. The patient had a painless, slow-growing right testicular mass, with normal serum tumor markers. Ultrasound and CT scans suggested malignancy. Post-orchiectomy, histopathology confirmed a spermatocytic tumor with polymorphic cells and lymphovascular invasion. Immunohistochemical staining was positive for SALL4 and CD117, negative for OCT4, AFP, and CD30. The patient underwent chemotherapy and remained recurrence-free for a year, highlighting the need for accurate diagnosis and long-term monitoring.

Breast cancer has become the most common malignant tumor in women, and its diagnosis and treatment principles mainly depend on the traditional histological and molecular pathological features. However, the systemic metastasis of breast cancer begins when cancer cells invade the primary tumor site as well as surrounding blood and lymphatic vessels. Pathologists have been able to distinguish between lymphatic and vascular invasion through a combination of immunohistochemical and vascular endothelial labelling techniques, and have recognized the role of lymphatic endothelial cells and vascular endothelial cells in tumor progression and metastasis. This paper summarizes the relevant clinical research progress and application of specific lymphovascular endothelial markers in breast cancer in recent years, in order to provide ideas for further revealing the progress mechanism of breast cancer and exploring new prognostic indicators and therapeutic targets for breast cancer.

The recent WHO classification of female genital tracts recommends cervical carcinomas to be further subtyped as HPV-associated and HPV-independent and accepted p16 immunoreactivity as a surrogate biomarker for HPV testing. This paper presents the clinicopathological spectrum of cervical carcinomas in correlation with p16 immunoreactivity. Aims and Objectives: This study aims to evaluate the immunoreactivity of p16 in cervical carcinoma, subtype them into HPV-associated and HPV-independent based on p16 immunoreactivity, and correlate them with clinicopathological features. Design: A hospital-based retrospective study of one-year duration was done after ethics approval. A total of 124 cases were identified, and various parameters like the presence of mitosis, lymphovascular invasion, tumor budding, tumor-infiltrating lymphocytes, the pattern of stromal invasion, and the pattern of necrosis were recorded and graded. Immunohistochemistry (IHC) with p16 marker was done in 40 cases, and immunoreactivity was correlated with clinical and histopathological parameters. Statistical Analysis: Multivariate analysis was done with Fisher's exact test, and a P value of

Objective: To evaluate the value of a machine learning model using enhanced CT radiomics features in the prediction of lymphovascular invasion (LVI) of esophageal squamous cell carcinoma (ESCC) before treatment. Methods: We reviewed and analyzed the enhanced CT images of 258 ESCC patients from June 2017 to December 2019. We randomly assigned the patients in a ratio of 7:3 to a training set (182 cases) and a validation (76 cases) set. Clinical risk factors and CT image characteristics were recorded, and multifactor logistic regression was used to screen independent risk factors of LVI of ESCC patients. We extracted the CT radiomics features using the FAE software and screened radiomics features using maximum relevance and minimum redundancy (MRMR) and least absolute shrinkage and selection operator (LASSO) algorithms, and finally, the radiomics labels of each patient were established. Five machine learning algorithms, namely, support vector machine (SVM), K-nearest neighbor (KNN), logistic regression (LR), Gauss naive Bayes (GNB), and multilayer perceptron (MLP), were used to construct the model of radiomics labels, and its clinical features were screened. The predictive efficacy of the machine learning model for LVI of ESCC was evaluated using the receiver operating characteristic (ROC) curve. Results: Tumor thickness [OR = 1.189, 95% confidence interval (CI) 1.060-1.351, P = 0.005], tumor-to-normal wall enhancement ratio (TNR) (OR = 2.966, 95% CI 1.174-7.894, P = 0.024), and clinical N stage (OR = 5.828, 95% CI 1.752-20.811, P = 0.005) were determined as independent risk factors of LVI. We extracted 1,316 features from preoperative enhanced CT images and selected 14 radiomics features using MRMR and LASSO to construct the radiomics labels. In the test set, SVM, KNN, LR, and GNB showed high predictive performance, while the MLP model had poor performance. In the training set, the area under the curve (AUC) values were 0.945 and 0.905 in the KNN and SVM models, but these decreased to 0.866 and 0.867 in the validation set, indicating significant overfitting. The GNB and LR models had AUC values of 0.905 and 0.911 in the training set and 0.900 and 0.893 in the validation set, with stable performance and good fitting and predictive ability. The MLP model had AUC values of 0.658 and 0.674 in the training and validation sets, indicating poor performance. A multiscale combined model constructed using multivariate logistic regression has an AUC of 0.911 (0.870-0.951) and 0.893 (0.840-0.962), accuracy of 84.4% and 79.7%, sensitivity of 90.8% and 87.1%, and specificity of 80.5% and 79.0% in the training and validation sets, respectively. Conclusion: Machine learning models can preoperatively predict the condition of LVI effectively in patients with ESCC based on enhanced CT radiomics features. The GNB and LR models exhibit good stability and may bring a new way for the non-invasive prediction of LVI condition in ESCC patients before treatment. [ABSTRACT FROM AUTHOR]

Objective: The overall 5-year survival for oral squamous cell carcinoma (OSCC) has not changed in the last 20 years despite advances in treatment. Lymphovascular invasion (LVI) has been shown to be a negative prognostic factor in other cancers, however its role in the prognosis of OSCC remains unclear. This study aims to determine if LVI is a predictor of cervical lymph node metastasis and/or recurrence in OSCC. Methods: We conducted a retrospective cohort review of patients from our institutional cancer registry who were treated for OSCC between 2004 and 2018. Patient demographics, surgical pathology results, and clinical outcome data were collected. A multivariable logistic regression analysis was performed to determine if LVI was an independent predictor of cervical lymph node metastasis and/or recurrence. Results: 442 patients were included, 32.8% were female and median age at time of diagnosis was 61.2 years. LVI was present in 32.8% of patients. When controlled for age, sex, t-classification, perineural invasion, depth of invasion (DOI), and margin status, LVI was a significant predictor of the presence of cervical node metastasis (OR: 3.42, CI: 2.17-5.39, P <.001). There was no significant association found between LVI and local recurrence (OR: 1.03, CI: 0.57-1.84, P =.92), regional recurrence (OR: 1.10, CI: 0.57-2.11, P =.78), or distant recurrence (OR: 1.59, CI: 0.87-2.94, P =.13). Conclusion: The results of this study suggest that LVI is a significant predictor of the presence of cervical lymph node metastasis at presentation independent of other known prognostic factors. LVI, however, was not found to be a significant independent predictor of locoregional or distant recurrence. Level of Evidence: Level III [ABSTRACT FROM AUTHOR]

Simple Summary: Early gastric cancer is a condition that can often be treated effectively if caught early. A less invasive treatment, known as endoscopic submucosal dissection (ESD), has become more popular for these early-stage cancers. However, deciding which patients are best suited for this treatment requires more information. This study looked into how the presence of cancer cells in the lymph or blood vessels, a condition called lymphovascular invasion (LVI), affects the chance of cancer returning or spreading in patients eligible for ESD. By reviewing the medical records of 1369 patients treated in Shanghai, we discovered that LVI greatly increases the risk of cancer spreading to the lymph nodes and negatively affects patients' survival rates. Our findings suggest that patients with LVI may need more aggressive treatment, such as surgery, to remove the cancer completely. This information could help doctors better decide on treatment plans for patients with early gastric cancer, potentially improving their chances of a successful recovery. This research highlights the importance of considering LVI in the treatment of early gastric cancer, which could lead to changes in how these patients are cared for in the future. Background: The management of early gastric cancer (EGC) has witnessed a rise in the utilization of endoscopic submucosal dissection (ESD) as a treatment modality, although prognostic markers are needed to guide management strategies. This study investigates the prognostic implications of lymphovascular invasion (LVI) in ESD-eligible EGC patients, specifically its implications for subsequent radical surgery. Material and methods: A retrospective, multicenter study from two primary hospitals analyzed clinicopathological data from 1369 EGC patients eligible for ESD, who underwent gastrectomy at Shanghai Cancer Center and Huashan Hospital between 2009 and 2018. We evaluated the relationship between LVI and lymph node metastasis (LNM), as well as the influence of LVI on recurrence-free survival (RFS) and overall survival (OS). Results: We found a strong association between LVI and LNM (p < 0.001). Advanced machine learning approaches, including Random Forest, Gradient Boosting Machine, and eXtreme Gradient Boosting, confirmed the pivotal role of LVI in forecasting LNM from both centers. Multivariate analysis identified LVI as an independent negative prognostic factor for both RFS and OS, with hazard ratios of 4.5 (95% CI: 2.4–8.5, p < 0.001) and 4.4 (95% CI: 2.1–8.9, p < 0.001), respectively. Conclusions: LVI is crucial for risk stratification in ESD-eligible EGC patients, underscoring the necessity for radical gastrectomy. Future research should explore the potential incorporation of LVI status into existing TNM staging systems and novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate cancer (PCa) patients often face uncertainties in treatment decisions, particularly regarding lymphadenectomy. This study, involving 96 PCa patients, explores the significance of lymphovascular invasion (LVI) laterality in influencing lymph node invasion (LNI) patterns. Out of these patients, 63.5% exhibited LVI exclusively on the left, 25.0% on the right, and 11.5% on both sides. Significant correlations were observed between LVI laterality and lymph node involvement (p < 0.001), especially on the right side. Left-sided LVI correlated with higher cancer stage (p = 0.047) and greater odds of bilateral lymph node involvement. This pioneering study emphasizes the need for future prospective, multi-center investigations, ideally incorporating preoperative LVI assessment, to refine PCa treatment decisions. Background. Lymphovascular invasion (LVI) is a vital but often overlooked prognostic factor in prostate cancer. As debates on lymphadenectomy's overtreatment emerge, understanding LVI laterality gains importance. This study pioneers the investigation into PCa, aiming to uncover patterns that could influence tailored surgical strategies in the future. Methods. Data from 96 patients with both LVI and lymph node invasion (LNI) were retrospectively analyzed. All participants underwent radical prostatectomy (RP) with modified-extended pelvic lymph node dissection (mePLND). All specimens underwent histopathological examination. The assessment of LVI was conducted separately for the right and left lobes of the prostate. Associations within subgroups were assessed using U-Mann–Whitney and Kruskal–Wallis tests, as well as Kendall's tau-b coefficient, yielding p-values and odds ratios (ORs). Results. Out of the 96 patients, 61 (63.5%) exhibited exclusive left-sided lymphovascular invasion (LVI), 24 (25.0%) had exclusive right-sided LVI, and 11 (11.5%) showed bilateral LVI. Regarding nodal involvement, 23 patients (24.0%) had LNI solely on the left, 25 (26.0%) exclusively on the right, and 48 (50.0%) on both sides. A significant correlation was observed between lateralized LVI and lateralized LNI (p < 0.001), particularly in patients with right-sided LVI only. LN-positive patients with left-sided LVI tended to have higher pT stages (p = 0.047) and increased odds ratios (OR) of bilateral LNI (OR = 2.795; 95% confidence interval [CI]: 1.231–6.348) compared to those with exclusive right-sided LVI (OR = 0.692; 95% CI: 0.525–0.913). Conclusions. Unilateral LVI correlates with ipsilateral LNI in PCa patients with positive LNs, notably in cases of exclusively right-sided LVI. Left-sided LVI associates with higher pT stages and a higher percentage of bilateral LNI cases. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate whether lymphovascular invasion (LVI) was associated with oncological outcomes in patients with prostate cancer (PCa) undergoing robotic-assisted radical prostatectomy (RARP). Methods: This retrospective multicenter cohort study was conducted on 3195 patients with PCa who underwent RARP in nine institutions in Japan. The primary endpoints were the associations between biochemical recurrence (BCR) and LVI and between BCR and clinicopathological covariates, while the secondary endpoints were the association between LVI and the site of clinical recurrence and metastasis-free survival (MFS). Results: In total, 2608 patients met the inclusion criteria. At the end of the follow-up period, 311 patients (11.9%) were diagnosed with BCR and none died of PCa. In patients with pathological stage T2 (pT2) + negative resection margins (RM−), and pT3+ positive RM (RM+), LVI significantly worsened BCR-free survival (BRFS). For patients with PCa who had pT3 and RM+, the 2-year BRFS rate in those with LVI was significantly worse than in those without LVI. Patients with LVI had significantly worse MFS than those without LVI with respect to pT3, RM+, and pathological Gleason grade (pGG). In multivariate analysis, LVI was significantly associated with BRFS in patients with pT3 PCa, and with worse MFS in PCa patients with pT3, RM+, and pGG ≥ 4. Conclusions: LVI was an independent prognostic factor for recurrence and metastasis after RARP, particularly in patients with pT3 and RM+ PCa. Locally advanced PCa with positive LVI and RM+ requires careful follow-up because of the high likelihood of recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Surgery represents the primary treatment option for cutaneous squamous cell carcinoma (cSCC) aiming for complete tumor resection (R0). Recurrence and metastasis significantly affect survival and outcomes, and poorly differentiated (G3) cSCC is associated with a higher risk of recurrence. However, the specific clinical and histopathological features that predict recurrence and progression in G3-cSCC remain unclear. Methods: A retrospective analysis was conducted on a series of patients with primary G3-cSCC diagnosed at the Turin University Hospital between January 2016 and January 2021. After independent histological revision, logistic regression models were used to identify clinico-pathological predictors of cutaneous recurrence, lymphnode/metastatic progression, and both types of progression. Results: Among the 161 G3-cSCC patients, 80.1% (129/161) showed no signs of local recurrence or metastatic progression, while 19.9% (32 patients) had progressed. In the univariate logistic regression, tumor clinical diameter, depth of infiltration (DOI), and lymphovascular invasion (LVI) were identified as significant predictors across the various types of progression (p < 0.05). In the context of multivariate logistic regression, distinct models proved to be significant. For skin recurrence, a 3-variable model incorporating DOI (OR 1.16, 95% CI, 1.01–1.35, p = 0.050), LVI (OR 3.61, 95% CI, 1.11–11.8, p = 0.034), and desmoplasia (OR 3.45, 95% CI, 1.25–9.5, p = 0.017) was selected. Regarding lymphnode/metastatic progression, a 3-variable model combining pT2 (OR 6.10, 95% CI, 1.15–32.35, p = 0.034), pT3 (OR 14.33, 95% CI, 2.79–73.63, p = 0.001), and LVI (OR 3.86, 95% CI, 1.10–13.62, p = 0.036) was identified. Lastly, a 2-variable model for both types of progression consisted of vertical tumor thickness (OR 5.45, 95% CI, 1.11–27.32, p = 0.039) and LVI (OR 1.15, 95% CI, 1.04–1.26, p = 0.006). Conclusion: Tumor size, DOI, and LVI were significant predictors of recurrence and metastatic progression. Notably, the size of histologically defined tumor-free margins did not affect the risk of recurrence, whilst LVI emerged as a key predictor of all forms of progression. These findings provide insights into risk stratification and suggest that close monitoring and potential adjuvant therapies, such as radiation therapy, may be necessary especially for patients with lymphovascular involvement. [ABSTRACT FROM AUTHOR]

The presence of lymphovascular invasion (LVI) in urothelial carcinoma (UC) is a poor prognostic finding. This is difficult to identify on routine hematoxylin–eosin (H&E)-stained slides, but considering the costs and time required for examination, immunohistochemical stains for the endothelium are not the recommended diagnostic protocol. We developed an AI-based automated method for LVI identification on H&E-stained slides. We selected two separate groups of UC patients with transurethral resection specimens. Group A had 105 patients (100 with UC; 5 with cystitis); group B had 55 patients (all with high-grade UC; D2-40 and CD34 immunohistochemical stains performed on each block). All the group A slides and 52 H&E cases from group B showing LVI using immunohistochemistry were scanned using an Aperio GT450 automatic scanner. We performed a pixel-per-pixel semantic segmentation of selected areas, and we trained InternImage to identify several classes. The DiceCoefficient and Intersection-over-Union scores for LVI detection using our method were 0.77 and 0.52, respectively. The pathologists' H&E-based evaluation in group B revealed 89.65% specificity, 42.30% sensitivity, 67.27% accuracy, and an F1 score of 0.55, which is much lower than the algorithm's DCC of 0.77. Our model outlines LVI on H&E-stained-slides more effectively than human examiners; thus, it proves a valuable tool for pathologists. [ABSTRACT FROM AUTHOR]

T1 colorectal cancers that infiltrate the submucosa have a risk of lymph node metastasis of about 10%, which is higher than in the colon. The criteria for additional treatment after endoscopic resection have been modified in the latest version of the French recommendations, opening up the possibility of curative resection in the case of lesions deeply invading the submucosa (sm2, sm3) in the absence of histopronostic factors with a poor prognosis. These factors are lymphovascular and neural invasion, budding ≥ 2, and tumour differentiation. Anatomopathological examination of the endoscopic specimen is therefore essential and a second opinion by an experienced pathologist may be recommended. In these cases, a monobloc resection is required, which has been made possible by advances in submucosal dissection techniques. The use of artificial intelligence, immunoscore and nomograms may help to predict the risk of lymph node metastasis and tailor management according to age and comorbidities. [ABSTRACT FROM AUTHOR]

Background: Current methods utilizing preoperative magnetic resonance imaging (MRI)‐based radiomics for assessing lymphovascular invasion (LVI) in patients with early‐stage breast cancer lack precision, limiting the options for surgical planning. Purpose: This study aimed to develop a sophisticated deep learning framework called "Prior Clinico‐Radiological Features Informed Multi‐Modal MR Images Convolutional Neural Network (PCMM‐Net)" to improve the accuracy of LVI prediction in breast cancer. By incorporating multiparameter MRI and prior clinical knowledge, PCMM‐Net should enhance the precision of LVI assessment. Methods: A total of 341 patients with breast cancer were randomly divided into training and validation groups at a ratio of 7:3. Imaging features were extracted from T1‐weighted, T2‐weighted, and contrast‐enhanced T1‐weighted MRI sequences. Stepwise univariate and multivariate logistic regression were employed to establish a clinico‐radiological model for LVI prediction. The radiomics model was built using redundancy and the least absolute shrinkage and selection operator. Then, two deep learning frameworks were developed: the Multi‐Modal MR Images Convolutional Neural Network (MM‐Net), which does not consider prior radiological features, and PCMM‐Net, which incorporates multiparameter MRI and prior clinical knowledge. Receiver operating characteristic curves were used, and the corresponding areas under the curves (AUCs) were calculated for evaluation. Results: PCMM‐Net achieved the highest AUC of 0.843. The clinico‐radiological features displayed the lowest AUC value of 0.743, followed by MM‐Net with an AUC of 0.774, and radiomics with an AUC of 0.795. Conclusions: This study introduces PCMM‐Net, an innovative deep learning framework that integrates prior clinico‐radiological features for accurate LVI prediction in breast cancer. PCMM‐Net demonstrates excellent diagnostic performance and facilitates the application of precision medicine. [ABSTRACT FROM AUTHOR]