Abstract
The status of lymph node involvement is an important prognostic factor for breast cancer. However, the presence of intratumoral lymphatic vessels in primary tumor lesions and the relationship between lymphatic vessel density (LVD) and lymph node metastasis (LNM) have not been firmly established. Therefore, we performed a meta-analysis study to investigate these issues. According to the pre-established inclusion and exclusion criteria, 13 studies, involving 1029 breast cancer patients, were included in this study. Using immunohistochemical staining, intratumoral lymphatic vessels were detected in 40.07% of breast cancer patients (240/599), and peritumoral lymphatics were detected in 77.09% (397/515). All studies demonstrated that peritumoral LVD was higher than intratumoral LVD, with a pooled standard mean difference and 95% confidence interval (95% CI) of 1.75 (1.28 to 2.21). Both intratumoral LVD and peritumoral LVD positively correlated with LNM, with correlation coefficients of 0.14 (95% CI 0.05 to 0.23) and 0.31 (95% CI 0.13 to 0.49), respectively. In summary, our study reports the overall detection rate of intratumoral lymphatics and demonstrates the associations between intratumoral LVD, peritumoral LVD, and LNM in breast cancer. Additionally, controlled studies with a larger number of subjects are needed to establish these relationships.
Highlights
Despite significant heterogeneity (P < 0.05, I2 = 95%), all studies indicated that peritumoral LVD values were higher than intratumoral LVD, with a pooled standard mean differences (SMDs) of 1.75
The pooled Fisher’s Z values for the relationships between intratumoral LVD and lymph node metastasis (LNM) and between peritumoral LVD and LNM were 0.14 and 0.33, respectively
Peritumoral LVD is significantly higher than intratumoral LVD in breast cancer (P < 0.05)
Summary
Among the 13 studies included, seven[10,11,13,14,16,17,21] reported the detection rate of intratumoral lymphatics, with an overall rate of 40.07% (240/599). Six of the included studies[10,11,13,14,16,17] reported the detection rate of peritumoral lymphatics, with an overall rate of 77.09% (397/515). Despite significant heterogeneity (P < 0.05, I2 = 95%), all studies indicated that peritumoral LVD values were higher than intratumoral LVD, with a pooled SMD of 1.75 (95% CI 1.28 to 2.21).
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