Is it useful to detect lymphovascular invasion in lymph node‐positive patients with primary operable breast cancer?

Abstract

BACKGROUND: Lymphovascular invasion (LVI) is a widely recognized prognostic factor in lymph node-negative breast cancers. However, there are only limited and controversial data about its prognostic significance in lymph node-positive patients. METHODS: Among 931 patients operated on and monitored at the authors' institution for an invasive breast carcinoma between 1989 and 1992, all 374 lymph node-positive breast cancers entered the study (median follow-up, 126 months). RESULTS: LVI was present in 46% of tumors and was associated with age 40 years (P ¼ .02), high histological grade (P ¼ .01), and negative estrogen receptor status (P ¼ .032), but not with tumor size, number of involved lymph nodes, or HER-2/neu status. LVI was an independent prognostic factor for distant metastases (P ¼ .002). Furthermore, in HER-2/neu-negative/hormone receptor-positive (n ¼ 287) tumors, the number of independent prognostic factors (LVI, age, histological grade, number of involved lymph nodes, and tumor size) was associated with a 5-years metastasis-free survival ranging from 100% if no factors (n ¼ 25) to 89% AE 2% if 1 or 2 factors (n ¼ 186) and 67% AE 6 if 3, 4, or 5 factors (n ¼ 76) were present (P < .001). CONCLUSIONS: LVI is an independent prognostic factor in lymph node-positive breast cancer and merits further prospective investigations as a decision tool in the adjuvant chemotherapy setting.

Prognostic significance of lymphatic invasion in lymph node-positive breast carcinoma: findings from a large case series with long-term follow-up using immunohistochemical endothelial marker

“…The same findings were reported in many previous studies [21][22][23][24] and from previous findings by our group. 2,7,8,15,25,26 The rate of LI in the current study was 47%, which lies in the same range as that reported in other studies: 28%, 20 46%, 13 and 55% 27 of patients with LN-positive BC in different patient cohorts. In our specimens, most of the LI lesions were detected in the peritumoral vessels (76% of LI-positive specimens).…”

“…In a similar study that examined vascular invasion using H&E-stained sections in 374 LNpositive BC specimens, it was found to be an independent poor prognostic factor for development of DM. 13 To determine in more detail the prognostic significance of LI in subgroups of BC according to number of positive axillary LNs, patients were divided into four groups (patients with one, two, three and more than three positive LNs). LI was significantly associated with shorter OS, shorter DFI, and higher risk for DM in patients with single positive LN, but not with patients having two, three or more than three positive LNs.…”

“…8 However, there still remains controversy in the literature regarding the relevance of assessment of vascular invasion in LN-positive BC. [9][10][11] Although recent studies have found a significant prognostic impact for vascular invasion in LN-positive disease, 12,13 methods for routine assessment of vascular invasion and standardization of its use in management are still in need for further assessment.…”

Overexpression of HER-2/neu in Malignant Mammary Tumors: Translation of Clinicopathological Features from Dog to Human

“…However, its interpretation is sometimes difficult. Previous studies have shown that, in the patients with positive LVI, prognosis is abated and overall survival is decreased (Mohammed et al, 2007;Ragage et al, 2010). In this study, although LVI was positive in 42.9% of all MMGTs, there was no statistical relationship between HER-2 positivity and LVI.…”

Prognostic and predictive factors of early breast cancer

“…Other prognostic factors, such as age, tumor location, histological grade, ER, PR, radiotherapy and systemic treatments also had no prognostic signifi cance. Regrettably lymphatic vascular invasion was not evaluated for incomplete data in pathologic reports [23,24] .…”