VI was detected in 56/177 specimens (32%); 54 (96%) were LVI and two (4%) were BVI. The presence of LVI was significantly associated with the presence of LN metastasis, development of distant metastasis, regional recurrence, and a worse disease-free interval and overall survival. In multivariate analysis, LVI retained a significant association with decreased disease-free interval and overall survival. When assessment of LVI using H&E was compared using the lymphatic marker, VI was missed in 30/177 (16.9%) and was falsely positive in 12/177 (6.8%) using H&E.