Just curious, what do others think on commenting on angiolymphatic invasion in the CAP tumor checklists in a situation when you don't see a clear cut invasion but there are lymph nodes positive for metastatic disease? I try to leave it out altogether (if it is asterisked and therefore optional). Any other approaches?
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Angiolymphatic invasion?
Started by Perry Mason
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I usually list LVI as "Not identified", to cover situations like this. Sections of the primary when there are lymph node mets don't always have LVI on the sections examined. It doesn't matter to the oncologists anyway, since they're going to treat based on the N status.
Always use "not identified", which doesn't mean it isn't there, just means it wasn't identified.
I saw mixed as a resident. Some did what's been suggested, others deleted the line reasoning "it's gotta be there if it's in the nodes", and rarely faculty asked for deepers and/or more sections to try and find it.
I usually delete it. Having the tumour in the lymph nodes is a strong evidence of angiolymphatic invasion. Therefore, stating "not identified" while you are seeing the tumour in the lymph nodes does not sound right. If insist, you can split it into (vascular invasion) and (lymphatic invasion). Put "not identified" for vascular invasion.
If it's not there it's not there. It becomes essentially irrelevant if you have nodal mets anyway. If clinicians don't understand how something can be in nodes and not have ALI in the examined sections, use it as a good topic for educating them on the limitations of histologic sampling.
