Interobserver variation in the identification of breast carcinoma in intramammary lymphatics

Gilchrist, Kennedy W.; Gould, Victor E.; Hirschl, Simon; Imbriglia, Joseph E.; Patchefsky, Arthur S.; Penner, D W; Pickren, John W.; Schwartz, Ira; Wheeler, James E.; Barnes, Janet M.; Mansour, Edward G.

doi:10.1016/s0046-8177(82)80121-4

Cited by 81 publications

(44 citation statements)

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“…7,8 The wide range of frequencies reported may be due to the difficulties of evaluation of LVI H&E-stained sections of the tumor whereby LVI is identified by presence of tumor emboli within vascular channels distinctly lined by a single layer of endothelial cells (H&E þ ). 15,16 This technique is subject to significant interobserver variability. 9,[15][16][17] The Eastern Cooperative Oncology Group reported that agreement in the identification of LVI in primary breast tumors by three pathologists occurred in only 12 out of 35 cases (34.2%).…”

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confidence: 99%

“…15,16 This technique is subject to significant interobserver variability. 9,[15][16][17] The Eastern Cooperative Oncology Group reported that agreement in the identification of LVI in primary breast tumors by three pathologists occurred in only 12 out of 35 cases (34.2%). 16 Difficulty arises in the visualization of lymphovascular invasion on H&E-stained slides for the following reasons.…”

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confidence: 99%

“…9,[15][16][17] The Eastern Cooperative Oncology Group reported that agreement in the identification of LVI in primary breast tumors by three pathologists occurred in only 12 out of 35 cases (34.2%). 16 Difficulty arises in the visualization of lymphovascular invasion on H&E-stained slides for the following reasons. Firstly, tumor emboli that completely obliterate the lumen of a vessel may be difficult to discern.…”

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confidence: 99%

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Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer

et al. 2007

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Monoclonal antibody D2-40, a marker of lymphatic endothelium, identifies tumor emboli in lymph vessels. The aim of the study was to assess whether D2-40 þ lymph vessel invasion (LVI) correlates with clinicopathologic factors including lymphovascular invasion (LVI) as assessed by haematoxylin and eosin-stained sections (H&E þ or H&EÀ) and to assess the prognostic significance in node-negative breast cancer. The study group consisted of 303 node-negative breast cancer patients that had a median follow-up of 7.6 years. Clinical and pathological data were retrieved from the Henrietta Banting database. Immunohistochemical staining was performed on formalin-fixed, paraffin-embedded tissue sections of the primary invasive carcinoma using D2-40. Immunostaining with CD31 was performed on the discordant cases that were H&E þ /D2-40À. D2-40 þ lymph vessel invasion was detected in 82/303 (27%) cases. The foci of lymphatic invasion occurred predominantly at the invasive front of the tumor. The absence of D2-40 and CD31 in 13/17 discordant cases was suggestive of retraction artefact. D2-40 þ lymph vessel invasion correlated significantly with age (P ¼ 0.0003), tumor size (P ¼ 0.005), histological grade (P ¼ 0.0001), H&E þ (P ¼ o0.0001) and estrogen receptor status (P ¼ 0.005) but not with histological type or progesterone receptor status. Multivariate analysis revealed that D2-40 þ lymph vessel invasion was the only significant predictor of distant recurrence. There was no significant association between D2-40 status and local recurrence (P ¼ 0.752) or regional recurrence (P ¼ 0.13). Both D2-40 þ lymph vessel invasion (P ¼ 0.009) and H&E þ LVI cases (P ¼ 0.02) were associated with overall shorter survival in univariate analysis. These data indicate that D2-40 identifies lymphatic invasion in breast tumors and is a significant predictor of outcome in breast cancer.

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Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer

et al. 2007

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“…This is well-known phenomenon in breast as well as other cancers. 6,17 In 35 specimens of breast cancer reported by Gilchrist et al, 18 complete agreement between pathologists regarding intra-mammary lymphatics was reached in only 12 cases. In 5 of the 35 cases there was complete disagreement and in 18 cases there was partial agreement.…”

Section: Discussionmentioning

confidence: 91%

The histology of peau d’orange in breast cancer – what are the implications for surgery?

Wiggett¹,

Louw²,

Karusseit³

2012

S Afr J Surg

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Introduction. Surgery is sometimes performed on patients with peau d' orange (dermal oedema) of the breast. This may be done to achieve local control of cancer after neo-adjuvant chemotherapy or in resectable locally advanced disease. Conventional practice is not to place excision lines through areas of peau d' orange for fear of recurrence in such an area. The question can be asked whether this wisdom is still valid in modern practice. No formal cohort studies documenting the histopathology of the skin in areas of peau d' orange have been published, and available descriptions are scanty.Aim. To describe the histopathological features of peau d' orange. Method. Consecutive patients undergoing mastectomy for cancer in whom peau d' orange was present were selected over a period of 2 years. Blocks of skin were excised from areas of peau d' orange and examined histologically. The presence, nature and location of malignant cells were recorded and correlated with lymph node pathology. Prior administration of neo-adjuvant chemotherapy was noted.

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“…Inflammatory breast carcinoma, in which there is diffuse lymphatic permeation of the breast and overlying skin, is one of the least favorable of all breast carcinoma types (114). Unfortunately, the variability with which vascular (especially lymphatic) invasion is identified by different pathologists is so great that this feature is of marginal overall usefulness (115).…”

Section: Tumor Invasivenessmentioning

confidence: 99%

Biological meaning of stage and grade in human breast cancer: Review and hypothesis

Sharkey

1982

Breast Cancer Res Tr

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SummaryBecause of the high probability that breast cancer patients have experienced systemic dissemination prior to their initial treatment, the determination of tumor stage and grade should not be considered an estimate of the likelihood of eventual metastasis. An examination of staging and grading parameters reveals strong associations among measures of tumor stage, and a relative independence of those measures from tumor grade. Similarly, measures of tumor grade tend to be expressed at approximately the same level in the individual patient, but are relatively independent of tumor stage, in clinical human breast cancer, tumor 'stage' would appear to be an estimate of body burden of tumor, and tumor 'grade' an estimate of growth rate. Together they provide, with some degree of probability, an estimate of the amount of time between initial presentation and recurrence. In order to increase the probability with which this estimate can be made, greater precision is needed in our determinations of prognostic indices, particularly those of tumor grade. Biochemical measurement of estrogen receptors and other biological products, and tumor morphometry, may help to alleviate this problem. Patient prognosis can best be evaluated by combining estimates of tumor stage and grade, rather than relying upon only one.

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Interobserver variation in the identification of breast carcinoma in intramammary lymphatics

Cited by 81 publications

References 6 publications

Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer

Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer

The histology of peau d’orange in breast cancer – what are the implications for surgery?

Biological meaning of stage and grade in human breast cancer: Review and hypothesis

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