The prognostic value of lymphatic and blood vessel invasion in operable breast cancer

Abstract

Background. This study assessed the prognostic effect of lymphatic and blood vessel invasion (LVI and BVI) on survival in a retrospective sample of 1408 patients with breast cancer. Methods. Survival analysis was evaluated by univariate (Kaplan‐Meier product limit method and log rank test) and multivariate (Cox model) analysis. Correlations among variables were studied by contingency tables and statistical significance was evaluated by chi‐square test. Results. Lymphatic vessel invasion was present in 34.2% of cases, and BVI in 4.2%. Lymphatic vessel invasion correlated with BVI (P < 0.0001), and both were correlated with metastatic axillary lymph nodes and increasing tumor size and grade; BVI was sporadic (only 10 cases) among lymph node negative patients. Although LVI was more frequent among premenopausal patients and those with ductal carcinomas, BVI was unrelated to menopausal status and tumor type. Lymphatic vessel invasion and BVI were associated with poor survival by univariate analysis (P < 0.0001). By multivariate analysis, relative risk of death was significantly increased when LVI was present both in the whole series as well as in the lymph node negative and lymph node positive subgroups; the prognostic role of LVI was independent of menopausal and lymph node status, tumor size, tumor grade, or adjuvant treatment. In the lymph node negative sample, LVI had strong prognostic power. In the lymph node positive sample, the prognostic role of LVI was also independent of the number of lymph nodes with metastases. Blood vessel invasion had no prognostic role in any subgroup. Conclusion. The prevalence of BVI was particularly low in this study, and the question of its possible prognostic role for patients with breast cancer should be assessed with methods that amplify its detection. LVI is a strong prognostic factor for operable patients with breast cancer. In lymph node negative patients, LVI is a predictor of poor prognosis for those who are consequently candidates for adjuvant therapy. Similarly, in lymph node positive patients, LVI is a predictor for a high risk of death for those who are candidates for highly intensive adjuvant strategies. Cancer 1995; 76:1772–8.

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

“…[1][2][3][4][5][6][7] In previous reports, LI was found to be independent poor prognostic factor in lymph node (LN)-negative breast cancer patients and has been recommended to be added to clinical management tools such as the 'Nottingham Prognostic Index (NPI)'. 8 However, there still remains controversy in the literature regarding the relevance of assessment of vascular invasion in LN-positive BC.…”

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

“…Some studies have shown that LVI is an indicator of increased risk of recurrence and of reduced overall survival. [2][3][4][5][6][7][8][9] LVI has also been shown to be a predictor of axillary lymph node metastasis. 7,[10][11][12][13] It has been proposed that LVI could be used to identify a subgroup of axillary node-negative patients with an unfavorable prognosis that are likely to benefit from adjuvant chemotherapy.…”

“…[2][3][4][5][6][7][8][9] LVI has also been shown to be a predictor of axillary lymph node metastasis. 7,[10][11][12][13] It has been proposed that LVI could be used to identify a subgroup of axillary node-negative patients with an unfavorable prognosis that are likely to benefit from adjuvant chemotherapy. [6][7][8] Furthermore the presence of peritumoral LVI, as assessed on haematoxylin and eosin-(H&E) stained slides, has recently been added to the St Gallen criteria for the selection of adjuvant systemic therapy in operable breast cancer.…”

“…7,[10][11][12][13] It has been proposed that LVI could be used to identify a subgroup of axillary node-negative patients with an unfavorable prognosis that are likely to benefit from adjuvant chemotherapy. [6][7][8] Furthermore the presence of peritumoral LVI, as assessed on haematoxylin and eosin-(H&E) stained slides, has recently been added to the St Gallen criteria for the selection of adjuvant systemic therapy in operable breast cancer. 14 The frequency of LVI ranges from 8% to 21% in lymph node-negative breast cancer patients 2,3,[6][7][8]15 and from 30% to 46% in lymph node-positive patients.…”

“…[6][7][8] Furthermore the presence of peritumoral LVI, as assessed on haematoxylin and eosin-(H&E) stained slides, has recently been added to the St Gallen criteria for the selection of adjuvant systemic therapy in operable breast cancer. 14 The frequency of LVI ranges from 8% to 21% in lymph node-negative breast cancer patients 2,3,[6][7][8]15 and from 30% to 46% in lymph node-positive patients. 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 ).…”