Expression of Vascular Endothelial Growth Factor (VEGF) in Cervical Squamous Intraepithelial Lesions and Invasive Squamous Cell Carcinoma

Open Access

Abstract

Background: Cervical cancer is the fourth most common cancer in women globally and is the second most common cancer in the women of Bangladesh. Studies have shown that development of cervical precancerous lesions and cancer is a multifactorial process in which HPV infection plays the central role. A small proportion of cervical precancerous lesions (Squamous intraepithelial lesions) progress to squamous cell carcinoma over time. Early detection and management of intraepithelial lesions can prevent invasive cancer. Tumor neovascularization plays crucial role in the development of cervical cancer like all other solid tumors. VEGF is a significant biomarker involved in tumor angiogenesis. Immunohistochemical expression of VEGF has shown to be expressed by the neoplastic cells. It has been reported that VEGF expression exhibits significant increase from low grade to high grade squamous lesions (LSIL, HSIL) to invasive carcinoma. Aim of the study: To evaluate the expression levels of VEGF in LSIL, HSIL and ISCC of cervix, and also to evaluate relationship of VEGF expression with histopathologic grades of ISCC. Methods & Materials: This cross-sectional study was conducted in the Department of pathology, Rajshahi Medical College, Rajshahi with support of Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of March 2021 to February 2023. Total seventy cases were included in this study with the histopathological diagnosis of LSIL, HSIL, and ISCC of cervix. Expression of VEGF was determined semi-quantitatively by assessing staining intensity and the percentage of stained tumor cells in formalin-fixed paraffin-embedded lesionsal blocks and expression was categorized as negative and positive. Result: In this study, the patients were between 30-80 years. LSIL diagnosis was more frequent in younger age group (<50 years), whereas proportion of HSIL and ISCC were more in older age group (≥50 years). The majority of the cases were ISCC of cervix 41 (58.6%) followed by HSIL 19 cases (27.2%) and LSIL 10 cases (14.3%). Positive VEGF expression was most frequently positive in ISCC (56.1%), followed by in HSIL (31.6%) and then in LSIL (10.0%). The association of the increasing grade of the cervical squamous lesions and carcinoma with VEGF expression status was statistically significant (p=0.016) in this study. Although positive VEGF expression was more frequently observed in Grade III ISCC (64.3%) than in Grade I (54.5%) and Grade II (50.0%), but this was not statistically significant (p=0.729). Conclusion: The study results show that positivity of VEGF expression was more frequent with invasive cervical carcinoma in comparison to HSIL and also more in HSIL in comparison to LSIL. Therefore, it can be suggested that tumour angiogenesis might be involved in progression of precancerous cervical lesions to invasive cancers.