Lymphovascular Invasion

Field Length:  1

This field indicates the presence or absence of tumor cells in lymphatic channels (NOT lymph nodes) or blood vessels within the primary tumor as noted microscopically by the pathologist.  It is a mandatory field for cases diagnosed January 1, 2010 onward.  

Note: This coding convention has been developed and implemented for use in the AJCC Cancer Staging Manual, Seventh Edition, and updated with new codes in the AJCC 8th Edition staging manual for appropriate disease sites. 

Note: Revised CAP Protocols and 8th Edition chapters will indicate which chapters will use the new codes (2, 3, and 4) and which will only use the existing codes (0,1,8,9), as there are some disease sites where distinguishing between L and V is not medically appropriate.

Note:  Code 8, Not Applicable for benign/borderline brain and CNS tumors.

Note: For cases diagnosed January 1, 2018 and later, new codes indicating lymphatic, small vessel and/or large vessel invasion were added.

Instructions for Coding

• This item may be left blank for cases diagnosed before 2010.

Definition

Lymphovascular invasion is defined as the presence of tumor cells found inside small blood vessels or lymphatic channels within the tumor and surrounding tissues in the primary site.  The tumor cells have broken free of the primary tumor and now have the capability to float throughout the body.  Other names for lymphovascular invasion are LVI, lymphovascular invasion, vascular invasion, blood vessel invasion, and lymphatic invasion.  Vascular invasion is not the same as direct tumor extension from the primary tumor into adjacent blood vessels; LVI cells are not attached to or growing into the wall of the blood vessel.  Lymphatic invasion is not the same as involvement of regional lymph nodes.  Lymphovascular invasion does not include perineural invasion. 

Coding Instructions

1. Code from pathology report(s). If not available, code the absence or presence of lymphovascular invasion as described in the medical record.

a. The primary source of information about lymphovascular invasion is the pathology check list (synoptic report) developed by the College of American Pathologists. If the case does not have a checklist or synoptic report, code from other sections of the pathology report or a physician’s statement, in that order.

2. Code lymphovascular invasion to 0, 2, 3, 4, or 9 for the following Schema IDs

• Thyroid 00730
• Thyroid Medullary 00740
• Adrenal Gland 00760

3. Do not code perineural invasion in this data item

4. Use the pathology report for any specimen from the primary site to code this data item (biopsy or resection)

5. Code as present/identified when lymphovascular invasion is identified in any primary tumor specimen

6. Use the table below for cases treated with neoadjuvant (preoperative) therapy. Code lymphovascular invasion based on the documentation in the medical record when documentation in the medical record conflicts with this table.

7. Use code 0

a. When the pathology report indicates that there is no lymphovascular invasion

b. For in situ cases

c. When there is no residual tumor found after neoadjuvant treatment and there is no LVI on biopsy

8. Use code 1 when the pathology report or a physician’s statement indicates that lymphovascular invasion (or one of its synonyms) is present in the specimen

a. Synonyms include, but are not limited to

i. Angiolymphatic invasion

ii. Blood vessel invasion

iii. Lymph vascular emboli

iv. Lymphatic invasion

v. Lymphvascular invasion

vi. Vascular invasion

vii. Lymphovascular space invasion

9. Use code 8

a. For the following Schemas/Schema IDs

• • GIST 00430
  • HemeRetic 00830
  • Lymphoma 00790
  • Lymphoma-CLL/SLL 00795
  • Lymphoma Ocular Adnexa 00710
  • Mycosis Fungoides (MF) 00811
  • Plasma Cell Disorder 00822
  • Plasma Cell Myeloma 00821
  • Primary Cutaneous Lymphoma (excluding MF and SS) 00812

For more information about schemas and schema IDs, go to the SSDI Manual, Appendix A.

b. For non-malignant brain (intracranial) and CNS tumors

c. When standard-setter does not require this item and state/central registry is not collecting it

10. Use code 9 when

a. There is no microscopic examination of a primary tissue specimen

b. The primary site specimen is cytology only or a fine needle aspiration

c. The biopsy is only a very small tissue sample

d. It is not possible to determine whether lymphovascular invasion is present

e. The pathologist indicates the specimen is insufficient to determine lymphovascular invasion

f. Lymphovascular invasion is not mentioned in the pathology report

g. There is no information/documentation from the pathology report or other sources

h. Primary site is unknown

i. Ambiguous terminology is used

Example: Assign code 9 for “suspicious LVI.”

Clarification between codes 8 and 9:

• Code 8 should only be used in the following situations:
  • 1. Standard-setter and central registry does not require this item and you are not collecting it.
  • 2. Those histologies noted above described in code 8 for which LVI is always not applicable.
• For those cases where there is no information/documentation from the pathology report or other sources, use code 9