Abstract
BackgroundLymphovascular invasion (LBVI) including lymphatic (LVI) and blood (BVI) vessel invasion is a critical step in cancer metastasis. In breast cancer, the optimal detection method of LBVI remains unclear. This research aimed to compare the prognostic value of different assessments of the LVI and BVI in patients with early breast cancer.MethodsThe study cohort included 360 patients with a median follow-up of 168 months. LBVI on H&E sections (LBVIH&E) was reviewed centrally and blinded to the pathology report. Immunohistochemical staining for D2-40 and Factor VIII was performed to identify LVID2–40 and BVIFVIII.ResultsLBVIH&E, LVID2–40 and BVIFVIII were present in 102 (28%), 127 (35%) and 59 (16%) patients respectively. In node-negative patients (206), LBVIH&E, LVID2–40 and BVIFVIII were present in 41 (20%), 53 (26%) and 21 (10%) respectively. In triple-negative patients (120), LBVIH&E, LVID2–40 and BVIFVIII were present in 35 (29%), 46 (38%) and 16 (13%) respectively. LBVIH&E was significantly associated with tumour recurrence in the whole cohort (P < 0.001), node-negative patients (P = 0.001) and triple-negative patients (P = 0.004). LVID2–40 and BVIFVIII were significantly associated with tumour recurrence in whole cohort, node-negative (all P < 0.001) and triple-negative patients (P = 0.002). In multivariate survival analysis, only LVID2–40 and BVIFVIII were independent predictors of cancer specific survival in the whole cohort (P = 0.023 and P < 0.001 respectively), node-negative patients (P = 0.004 and P = 0.001 respectively) and triple-negative patients (P = 0.014 and P = 0.001 respectively).ConclusionAssessment of LVI and BVI by IHC using D2-40 and Factor VIII improves prediction of outcome in patients with node-negative and triple-negative breast cancer.
Highlights
Lymphovascular invasion (LBVI) including lymphatic (LVI) and blood (BVI) vessel invasion is a critical step in cancer metastasis
While LBVI on haematoxylin and eosin (H&E) sections (LBVIH&E) was strongly associated with LBVIIHC (P < 0.001), 80 (22%) patients in whom LBVIH&E had not been identified were positive for LVID2-40 and/or BVIFVIII
The results of the present study show that LBVIH&E, LVID2-40 and BVIFVIII all predicted tumour recurrence and cancer specific survival in an observational cohort of patients with early breast cancer
Summary
Lymphovascular invasion (LBVI) including lymphatic (LVI) and blood (BVI) vessel invasion is a critical step in cancer metastasis. Breast cancer is a common cancer in female and one of the leading causes of cancer death in women. It accounts for approximately one tenth of all new cancers and a quarter of all female cancer cases [1]. Lymphovascular invasion (LBVI) including lymphatic (LVI) and blood (BVI) vessel invasion is a critical step in. Staging guidelines of the American Joint Cancer Committee on Cancer (2005) mandates distinguishing between lymphatic and blood vessel invasion, these guidelines lack a routine standardised and objective assessment method to reliably differentiate them [20]. It remains a challenge to distinguish true LVI and BVI from retraction artifacts caused by tissue handling, fixation and processing on haematoxylin and eosin (H&E) stained sections [21,22,23]
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