title: Assessment of vascular invasion in gastric cancer: a comparative study.
abstract: OBJECTIVE
  To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematoxylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node status.
  
  
  METHODS
  IHC using D2-40 (a lymphatic endothelial marker) and CD34 (a pan-endothelial marker) was performed to study LVI and BVI in surgical specimens from a consecutive series of 95 primary gastric cancer cases. The results of the IHC study were compared with the detection by HE using McNemar test and kappa index. The morphologic features of the tumors and the presence of LVI and BVI were related to the presence of lymph node metastasis. A χ(2) test was performed to obtain associations between LVI and BVI and other prognostic factors for gastric cancer.
  
  
  RESULTS
  The detection rate of LVI was considerably higher than that of BVI. The IHC study identified eight false-positive cases and 13 false-negative cases for LVI, and 24 false-positive cases and 10 false-negative cases for BVI. The average Kappa value determined was moderate for LVI (κ = 0.50) and low for BVI (κ = 0.20). Both LVI and BVI were statistically associated with the presence of lymph node metastasis (HE: P = 0.001, P = 0.013, and IHC: P = 0.001, P = 0.019). The morphologic features associated with LVI were location of the tumor in the distal third of the stomach (P = 0.039), Borrmann's macroscopic type (P = 0.001), organ invasion (P = 0.03) and the depth of tumor invasion (P = 0.001). The presence of BVI was related only to the depth of tumor invasion (P = 0.003).
  
  
  CONCLUSIONS
  The immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of vessel invasion and for predicting lymph node metastasis.
authors.affiliation: Department of Anatomic Pathology and Medicine, University Federal of Minas Gerais, Belo Horizonte 30130-100, Brazil. letrivellato@gmail.com
authors.forename: Letícia Trivellato
authors.initials: LT
authors.lastname: Gresta
authors.forename: Ismael Alves
authors.initials: IA
authors.lastname: Rodrigues-Júnior
authors.forename: Lúcia Porto Fonseca
authors.initials: LP
authors.lastname: de Castro
authors.forename: Geovanni Dantas
authors.initials: GD
authors.lastname: Cassali
authors.forename: Mônica Maria Demas Álvares
authors.initials: MM
authors.lastname: Cabral
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000378:metabolism; D018952:Antigens, CD34 / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D016591:Histocytological Preparation Techniques / Q000379:methods*; D006801:Humans; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D009389:Neovascularization, Pathologic / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018952:Antigens, CD34; D014408:Biomarkers, Tumor; C500987:monoclonal antibody D2-40
keywords: Blood vessel invasion; CD34; D2-40; Gastric cancer; Immunohistochemistry; Lymph node metastasis; Lymphatic vessel invasion; Predictive factor; Tumour-node-metastesis staging