Detection of lymphovascular invasion in vulvar cancer by D2-40 (podoplanin) as a predictor for inguinal lymph node metastases.
BACKGROUND
Lymphatic vessel invasion (LVI) plays a major role in the spread of vulvar cancer and predicts regional lymph node metastasis. D2-40, a monoclonal immunohistochemical marker might be able to increase the detection rate of LVI compared to conventional hematoxylin-eosin (HE) staining. The aim of the study was to evaluate the suitability of D2-40 for the prediction of regional lymph node metastases.


METHODS
Immunohistochemical staining with D2-40 was performed on formalin-fixed, paraffin-embedded tissue sections of 32 patients with squamous cell carcinoma of the vulva. Slides were screened for the presence of LVI. Correlation with clinico-pathological features including LVI as retrieved by routine HE-stained sections was assessed.


RESULTS
Immunostaining with D2-40 significantly (p = 0.019) increased the frequency of detection of lymphatic invasion compared to conventional HE staining. LVI was correctly identified by D2-40 (D2-40+ LVI) in 65.6% of tumor specimens as compared to 40.6% by routine HE staining (HE+ LVI). D2-40+ LVI significantly (p = 0.026) predicted inguinal lymph node metastases.


CONCLUSIONS
Immunostaining with D2-40 significantly increased the frequency of detection of lymphatic invasion compared to conventional HE staining in squamous cell carcinomas of the vulva. D2-40+ LVI is a strong predictor for inguinal lymph node metastases.
Braun
Michael
M
Department of Obstetrics and Gynecology, Centre of Integrated Oncology Cologne-Bonn, Germany. Michael.braun@ukb.uni-bonn.de
Wardelmann
Eva
E
Debald
Manuel
M
Walgenbach-Bruenagel
Gisela
G
Höller
Tobias
T
Wolfgarten
Matthias
M
Sauerwald
Axel
A
Rudlowski
Christian
C
Büttner
Reinhard
R
Kuhn
Walther
W
Pölcher
Martin
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000032:analysis*; D058846:Antibodies, Monoclonal, Murine-Derived; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary*; D005260:Female; D006119:Groin; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014846:Vulvar Neoplasms / Q000473:pathology*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40