CRGC Reporting Advisory

 RA   2014-006

Lymph-vascular 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. Other names for lymph-vascular invasion are LVI, lymphovascular invasion, vascular invasion, blood vessel invasion, and lymphatic invasion.  The following is a clarification when to use codes 0, 8, and 9.   

• Use code 0 - Lymph-vascular invasion not present (absent)/Not identified, the tumor behavior is 0, 1, or 2

Rationale: Benign, borderline and in-situ neoplasms cannot have lymphatic or vascular invasion by definition. When any invasion is present, the neoplasm is classified as malignant with behavior = 3.   

• Use code 8 - Not applicable, when histology = 9590-9992 (ALL lymphoid and myeloid neoplasms).

Rationale: Only solid tumors have LVI. Lymphoid and myeloid neoplasms (neoplasms that originate in the lymphatic system, bone marrow, or in circulating blood) cannot have lymphatic or vascular invasion.      

• Use code 9 - Unknown if lymph-vascular invasion present, no tissue from the primary site was examined pathologically (invasive solid tumors only).

Rationale: Lymph-vascular invasion or LVI indicates the presence or absence of tumor cells in small lymphatic channels (not lymph nodes) or small blood vessels within the primary tumor or in the surrounding tissues of the primary site as noted microscopically by the pathologist. When a neoplasm shows the presence of lymph-vascular invasion, tumor cells have broken free of the primary tumor and now have the ability to float throughout the body.

    Citations: CAnswer Forum, Ask A Pathologist, "DCIS with LVI"

                    CAnswer Forum, Breast, "In Situ with LVI"