Detection of lymphatic vessel invasion in early breast cancer by the monoclonal antibody D2–40 (podoplanin)

Abstract

22042 Background: The purpose of this study was to compare the detection of lymphovascular invasion (LVI) by D2–40 (podoplanin) immunostaining with conventional hematoxylin-eosin (H.E.) staining in early breast cancer. We also aimed to find associations between the detection of D2–40 + LVI and other clinicopathological variables. Methods: Immunohistochemical staining with D2–40 and CD 34 and conventional H.E. staining was performed on consecutive formalin-fixed, paraffin-embedded tissue sections of 254 invasive breast tumors of 247 patients with node negative and node positive early breast cancer. For every tumor, the whole particular section, stained with H.E., CD34 and D2–40 was screened for the presence of lymphatic invasion Correlation with clinico-pathological factors and the eligibility for the prediction of axillary lymph node metastases was assessed. Results: LVI was identified by D2–40 (D2–40+) in 70 out of 254 tumors (28%) as compared to 40 tumors (16%) by routine HE staining (HE+). The increase of LVI detection was significant (p<0.001). Significant correlation was observed between D2–40+ LVI and age, t-stage, nodal status, grading and “triple negative” tumors (ER/PR and HER2neu negative). There was no correlation between D2–40+ LVI and menopausal-status, HER2-status and histological type. Based on multivariate analysis D2–40+ LVI was the strongest predictor for axillary lymph node metastases (OR = 3.489, p=0.0003), followed only by T-stage and grading (OR = 3.167 and 1.953, p=0.0003 and 0.0352). For 5 out of 35 patients (15%) with primary or secondary mastectomy who did not receive adjuvant radio-therapy, management would have changed to postmastectomy radiation in retrospect because of additional detected LVI by D2–40 immunostaining. Conclusions: Immunostaining with the monoclonal antibody D2–40 significantly increased the frequency of detection of lymphatic invasion compared to conventional H.E. staining in early breast cancer. Immunohistochemical detection of LVI by D2–40 might be of value in clinical practice. No significant financial relationships to disclose.