Preoperative predictors of lymphovascular space invasion in endometrial cancer –⁠ a review of current evidence

Czech version

Authors: V. Kačurik ¹; P. Bretová ¹; M. I. Ndukwe ^1,2; S. Křížová ³; J. Laco ⁴
Authors‘ workplace: Porodnická a gynekologická klinika LF UK a FN Hradec Králové ¹; Klinika onkologie a radioterapie LF UK a FN Hradec Králové ²; 1. lékařská fakulta UK, Praha ³; Fingerlandův ústav patologie LF UK a FN Hradec Králové ⁴
Published in: Ceska Gynekol 2026; 91(5): 417-423
Category:
doi: https://doi.org/10.48095/cccg2026417

Overview

The aim of this review article is to summarize current possibilities for the preoperative prediction of lymphovascular space invasion in endometrial carcinoma, which represents an important prognostic factor associated with a higher risk of lymph node metastases, disease recurrence, and reduced overall survival. The text summarizes findings from clinical studies with a focus on imaging methods, role of histopathological and molecular markers, serum biomarkers, and predictive models. Imaging methods indicate an association between lymphovascular space invasion and deep myometrial invasion, cervical stromal involvement, and larger tumor size. Advanced approaches, such as quantitative analysis of magnetic resonance imaging data or magnetic resonance elastography, enable noninvasive assessment of tumor biological aggressiveness and improve estimation of the presence of lymphovascular space invasion. Histopathological and molecular tumor characteristics also play an important role. An increased risk of lymphovascular space invasion is observed in tumors with high chromosomal instability and impaired p53 protein function. Expression of the L1 cell adhesion molecule in tumor tissue and elevated serum levels of cancer antigen 125 and human epididymis protein 4 may further contribute to identifying patients at a higher risk. Integration of clinical, imaging, and molecular data into predictive models allows more precise risk stratification and potential individualization of surgical and adjuvant management; however, their routine use still requires further prospective validation.

Keywords:

endometrial cancer – magnetic resonance imaging – radiomics – L1 cell adhesion molecule – lymphovascular space invasion – cancer antigen 125 – human epididymis protein 4 – prediction models

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