A 62-year-old postmenopausal woman has endometrial carcinoma. Hysterectomy specimen shows endometrioid adenocarcinoma grade 2 with myometrial invasion to 60% depth, lymphovascular space invasion (LVSI), and no lymph node metastasis. According to FIGO 2023 revised staging for endometrial carcinoma, what stage does extensive LVSI specifically confer?
- A FIGO Stage IA, not affected by LVSI
- B LVSI upgrades the tumour directly to Stage IIIA
- C FIGO Stage IB (> 50% myometrial invasion without LVSI) is upstaged to Stage IC when extensive/substantial LVSI is present ✓
- D LVSI has no independent staging value in FIGO 2023
Explanation
FIGO 2023 revised staging for endometrial carcinoma introduced LVSI as a staging criterion for the first time. Stage IC is a new subcategory: endometrial carcinoma with any myometrial invasion plus substantial/extensive LVSI (previously considered Stage IB tumours with LVSI were still Stage IB). Extensive/substantial LVSI is now independently upstaged to Stage IC. This reflects evidence that extensive LVSI carries a prognosis similar to deeper invasion and significantly increases lymph node metastasis risk. Focal LVSI does not trigger this upstaging. This parallels the 2023 molecular classification integration, where aggressive molecular subtypes also affect staging.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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