Correlation of Coagulation Markers With Axillary Lymph Node Metastasis in Carcinoma Breast

Abstract

BACKGROUNDThe relationship between malignancy and thrombosis is known for over 100 years. Thrombocytosis, an increase in fibrinogen and fibrin degradation products like D-dimer arise in factors V, VII, VIII, IX and XI levels and a decrease in antithrombin III are seen in cancer patients. Extracellular remodeling of fibrin is essential for angiogenesis in tumours and activation of intravascular fibrin formation and degradation has been shown to occur in the plasma of breast cancer patients. The objectives of this study are-1. To correlate plasma level of coagulation markers (D-dimer) with clinico-pathological stage of carcinoma breast. 2. To assess role of coagulation markers (D-dimer) value as predictive markers of lymph node metastasis in breast cancer. 3. To assess changes in D-dimer values according to increasing (pathological) lymph node involvement. MATERIALS AND METHODSThis study was conducted in the Department of Surgery in Dr. S. N. Medical College, Jodhpur, Rajasthan, India and included 25 patients admitted in surgery ward from January 2016 to June 2017 (Prospective study). HPE of breast specimen was done and pathological examination report were analysed with Plasma D-Dimer value. RESULTSThere was statistically significant correlation between mean values of plasma D-Dimer and advancing stage of disease, tumour size, histological grade and lymphovascular invasion. BACKGROUND Breast cancer is the most common cancer in women and accounts for 29% of all cancers diagnosed each year in women all over the world. 1 Considering the magnitude of problem, it becomes of paramount importance to take various patients and tumour characteristics into consideration while chalking out the treatment plan for the patient. Lymph node metastasis has been shown to be the most important prognostic marker for carcinoma breast. 2,3 Lymph node involvement is not only a prognosis marker, but also an important guiding factor in deciding surgical plan as well as postoperative therapy. Presently, sentinel lymph node biopsy is considered gold standard to assess lymph node metastasis in carcinoma breast with clinically negative axilla. 4 'Financial or Other Competing Interest': None. Submission 04-10-2017, Peer Review 10-11-2017, Acceptance 18-11-2017, Published 27-11-2017. Corresponding Author: Dr. Man Singh Bairwa, Room No. 18, First Floor, P. G. Hostel, MGH Campus, Jodhpur-342001, Rajasthan. E-mail: drmansinghb@gmail.com DOI: 10.14260/jemds/2017/1402 Search for a marker, which can predict lymph node metastasis in clinically negative axilla has been a matter of research for long. 5 There is ample evidence that the components of the coagulation/ fibrinolytic system play an important role in cancer biology and angiogenesis. Fibrin deposition and remodeling in extracellular matrix of the tumour is an important initial step in tumour metastasis. For a tumour to successfully metastasise from its primary location, it must undergo several obligate steps including the invasion into either the lymphatic or vascular lumen, tr...

Correlation of coagulation markers with axillary lymph node metastasis in breast malignancy: a tertiary care centre study in North India

“…We found significant relationship between D-dimer and Factor VII and VIII levels and number of lymph nodes involved pathologically. Our study further confirms the similar findings of other studies done by Khangarot et al, Choudhary et al, Yigit et al and Blackwell et al 9,11,12,14 Yigit et al showed this relationship to be significant only when number of lymph nodes is more than 10. 11 As axillary lymph node involvement is most important prognostic factor, this relationship inspires confidence in suggesting D-dimer along with factor VII and VIII levels as prognostic factors, further these factors may be used in those patients who are node negative for an individualized assessment and use of systemic therapy.…”

“…There was no statistically significant difference found between either D-dimer or factor VII & VIII levels according to increase in tumor size. Similar results were also seen in another study done by Choudhary et al 14 In contrast to our result, Blackwell et al showed a significant correlation between tumor size and D-dimer levels. 12 This may be because of the greater sample size in their study group and the large variance possible in mean tumor size.…”

“…Similar results were reported by other studies when D dimer and factor 'VIII levels were compared with histologic grade of tumor. 14 No any previous study had compared factor VII levels with the tumor size of histological grade of disease.…”