Diagnostic concordance of reporting lymphovascular invasion in breast cancer

Rakha, Emad A.; Abbas, Areeg; Ahumada, Pablo Pinto; El-Sayed, Maysa E.; Colman, D.; Pinder, Sarah; Ellis, Ian O.

doi:10.1136/jclinpath-2017-204981

Cited by 19 publications

(14 citation statements)

References 21 publications

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“…However, we were able to retrieve approximately 85% of LVI and PNI statuses. Further, pathological information for LVI and PNI was obtained from the original reports through TIES, and these reports were not validated or standardized [51]. Third, whereas TCGA has significant benefits, with a large amount of transcriptomic information associated with patient survival, it also has limitations, such as a relatively short follow-up duration, as well as no detailed information available for neoadjuvant or adjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Transcriptomic Profile of Lymphovascular Invasion, a Known Risk Factor of Pancreatic Ductal Adenocarcinoma Metastasis

Takahashi

Katsuta

Yan

et al. 2020

Cancers

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Lymphovascular invasion (LVI) is an aggressive pathologic feature and considered a risk factor for distant metastasis. We hypothesized that pancreatic ductal adenocarcinomas (PDACs) with LVI are associated with shorter survival, as well as aggressive cancer biology and lymphangiogenesis in transcriptomic analysis. Utilizing the cancer genome atlas (TCGA)-PDAC cohort, we found that positive LVI was significantly associated with positive perineural invasion (PNI) (p = 0.023), and higher American Joint Committee on Cancer (AJCC) T (p = 0.017) and N (p < 0.001) categories. Furthermore, positive LVI was associated with shorter overall survival (OS) (p = 0.014) and was an independent risk factor of poor OS. Although there was no association between LVI status and lymphangiogenesis, epithelial-mesenchymal transition (EMT), or metastasis-related genes, Gene Set Enrichment Analysis revealed a strong association with cell-proliferation-related gene sets such as mitotic spindles (Normalized enrichment score (NES) = 1.76, p = 0.016) and G2/M checkpoints (NES = 1.75, p = 0.036), as well as with transforming growth factor beta (TGF-beta) signaling (NES = 1.61, p = 0.043), which is a known mechanism of metastasis in PDACs. In conclusion, positive LVI was an independent risk factor of poor OS in PDACs. We found that PDACs with LVI were possibly associated with accelerated cell proliferation and enhanced TGF-beta signaling independent of lymphangiogenesis. Transcriptomic profiling elucidates more precise tumor biology of LVI-positive PDACs.

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Section: Discussionmentioning

confidence: 99%

Transcriptomic Profile of Lymphovascular Invasion, a Known Risk Factor of Pancreatic Ductal Adenocarcinoma Metastasis

Takahashi

Katsuta

Yan

et al. 2020

Cancers

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“…Among patients with both an RS and N0 status, LVI was associated with worse OS in those with RS 11-25 (HR ¼ 1.31, 95% CI 1.09-1.57) and 26-100 (HR ¼ 1.58, 95% CI 1.30-1.93), but not RS 0-10 (HR ¼ 1.1, 95% CI 0.77-1.53), although there was no statistically significant interaction between LVI and RS. The authors concluded that while LVI did not predict chemotherapy benefit in those with intermediate RS (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), it did add prognostic information in ER-positive, HER2-negative, N0 BC with RS (11-100). 17 Both of these studies' findings further support those of the Trial Assigning Individualized Options for Treatment (TAILORX) study which, though did not evaluate LVI, similarly demonstrated that while patients with an intermediate-risk Oncotype DX score (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) did not receive an overall benefit from AC, certain patients (pre-menopausal with RS 16-25) could still derive some advantages, especially when high-risk clinical features such as tumor size and/or grade were present.…”

Section: Esmo Openmentioning

confidence: 99%

“…The authors concluded that while LVI did not predict chemotherapy benefit in those with intermediate RS (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), it did add prognostic information in ER-positive, HER2-negative, N0 BC with RS (11-100). 17 Both of these studies' findings further support those of the Trial Assigning Individualized Options for Treatment (TAILORX) study which, though did not evaluate LVI, similarly demonstrated that while patients with an intermediate-risk Oncotype DX score (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) did not receive an overall benefit from AC, certain patients (pre-menopausal with RS 16-25) could still derive some advantages, especially when high-risk clinical features such as tumor size and/or grade were present. 39,40 Taken together, the results of our own study and those of these studies evaluating RS suggest the existence of subgroups of patients with intermediate RS that may not normally receive AC but for whom other prognostic factors, LVI in particular, may indicate clinical benefit.…”

Section: Esmo Openmentioning

confidence: 99%

Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study

Houvenaeghel

Cohen

Classe³

et al. 2021

ESMO Open

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Background: We determined the prognostic impact of lymphovascular invasion (LVI) in a large, national, multicenter, retrospective cohort of patients with early breast cancer (BC) according to numerous factors. Patients and methods: We collected data on 17 322 early BC patients treated in 13 French cancer centers from 1991 to 2013. Survival functions were calculated using the KaplaneMeier method and multivariate survival analyses were carried out using the Cox proportional hazards regression model adjusted for significant variables associated with LVI or not. Two propensity score-based matching approaches were used to balance differences in known prognostic variables associated with LVI status and to assess the impact of adjuvant chemotherapy (AC) in LVI-positive luminal A-like patients. Results: LVI was present in 24.3% (4205) of patients. LVI was significantly and independently associated with all clinical and pathological characteristics analyzed in the entire population and according to endocrine receptor (ER) status except for the time period in binary logistic regression. According to multivariate analyses including ER status, AC, grade, and tumor subtypes, the presence of LVI was significantly associated with a negative prognostic impact on overall (OS), disease-free (DFS), and metastasis-free survival (MFS) in all patients [hazard ratio (HR) ¼ 1.345, HR ¼ 1.312, and HR ¼ 1.415, respectively; P < 0.0001], which was also observed in the propensity score-based analysis in addition to the association of AC with a significant increase in both OS and DFS in LVI-positive luminal A-like patients. LVI did not have a significant impact in either patients with ER-positive grade 3 tumors or those with ACtreated luminal A-like tumors. Conclusion:The presence of LVI has an independent negative prognostic impact on OS, DFS, and MFS in early BC patients, except in ER-positive grade 3 tumors and in those with luminal A-like tumors treated with AC. Therefore, LVI may indicate the existence of a subset of luminal A-like patients who may still benefit from adjuvant therapy.

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“…This precluded separate subgroup analyses for vascular and lymphatic invasion and highlights the need for pathologists to report these features separately to facilitate future studies and clearer risk stratification. It should also be noted that there is data to suggest that there may be significant inter‐observer variability between pathologists in the reporting of LVI in other solid organ cancers and specifically vascular invasion in follicular thyroid carcinoma 19–21 . To our knowledge, this has not been studied in PTC to date.…”

Section: Discussionmentioning

confidence: 94%

Lymphovascular invasion and risk of recurrence in papillary thyroid carcinoma

Wagner

Abraham

Tran

et al. 2020

ANZ Journal of Surgery

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Background Lymphovascular invasion (LVI) is an established adverse prognostic factor in many cancers, however, there are few studies assessing its significance in papillary thyroid carcinoma (PTC). We aimed to determine if LVI is an independent prognostic factor in PTC. Methods We conducted a single institution retrospective analysis of 610 patients with PTC treated between 1987 and 2016. LVI was defined as the presence or absence of cancer cells in blood vessels and/or lymphatics on histopathology. Multivariate Cox regression analysis was used to evaluate the association between LVI and recurrence‐free survival (RFS). Results The study cohort included 481 (78.9%) females and 129 (21.1%) males, with a median age of 47.6 years and median follow‐up of 3.4 years. LVI was present in 56 (9.2%) patients and was associated with nodal metastases (P < 0.001), extrathyroidal extension (P < 0.001), extranodal extension (P < 0.001), multifocality (P = 0.018) and microscopic positive margins (P < 0.001). On univariate analysis, LVI was associated with reduced RFS (hazard ratio (HR) 2.3; 95% confidence interval (CI) 1.3–4.3; P = 0.007). However, after adjusting for nodal stage (pN0, pN1a, pN1b) there was no association between LVI and RFS (HR 1.3; 95% CI 0.7–2.5; P = 0.398). Similar results were obtained in full multivariate models adjusting for additional prognostic factors (HR 1.2; 95% CI 0.6–2.4; P = 0.627). Conclusion LVI is strongly associated with other adverse prognostic factors in PTC, particularly the presence and extent of nodal metastases. However, after adjusting for these, LVI is not an independent predictor of recurrence.

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Diagnostic concordance of reporting lymphovascular invasion in breast cancer

Cited by 19 publications

References 21 publications

Transcriptomic Profile of Lymphovascular Invasion, a Known Risk Factor of Pancreatic Ductal Adenocarcinoma Metastasis

Transcriptomic Profile of Lymphovascular Invasion, a Known Risk Factor of Pancreatic Ductal Adenocarcinoma Metastasis

Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study

Lymphovascular invasion and risk of recurrence in papillary thyroid carcinoma

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