Grade 3 with "Focal " Lymphovascular Invasion

Anonymous

Grade 3 with "Focal " Lymphovascular Invasion

PamJ23

Hey everyone, I'm new here. Was diagnosed with idc on April 27th from core biopsy. Had lumpectomy on May 9th and my pathology results are: invasive ductal carcinoma size 14mm with dcis present with clear margins. Both are grade 3 and my primary tumour is PT1C, i don't know my hormone receptor status yet. The part that really worries me (other then the grade 3) is that is says focal lymphovascular invasion is present. Can anyone tell me anything about this?

Thanks so much for listening,

Pam

bluepearl

LVI means that they have seen lymph channels and/or blood vessels within the tumour. That said, extensive is more important than focal. What will also be more important are the hormone receptors and her2, lymph node status, and if hormone positive, your oncotype score to see whether chemo will benefit you or not. Oddly, some grade 3's don't require chemo while some grade one's do....so best to have that checked. 1.4cm is early stage. First I had LVI then I didn't....but someone correct me if I am wrong, focal invasion doesn't impact your treatment nor your risks.

Tinkerbells

Pam,

Thank you for posting this. You made me dig up my own pathology report, and after all this time I was not aware my LVI was focal, like yours. Not sure if it makes a difference or not so I am also eager to hear everyone's input.

My pathology report also reminds me I had 2 nodes, not 3 removed. I think I was so absolutely terrified by my diagnosis it was hard to keep things straight!

Xoxo

PamJ23

bluepearl thanks for the info, that makes me feel a bit more calm about it. I should know my hormone status Monday of next week I hope! Just want to get things rolling. They only removed one lymphnode and it was negative. Wish there were more removed to make sure!

Tinkerbells thanks for your help as well. This seems to be such an unknown area of concern. If we read anything about it it all looks scary! Hopefully the focal means they caught it in time .

Thanks ladies

PamJ23

Anyone else with focal LVI or any info on it?

BarredOwl

Hi PamJ23:

Here is a link to the main site here with general information and an illustration of lymphovascular invasion ("LVI"):

>>http://www.breastcancer.org/symptoms/diagnosis/vasc_lymph_inv

A key point is that the presence of lymphovascular invasion in the vicinity of the tumor ("peritumoral") is not the same thing as lymph node involvement.

The circulatory system includes two types of channels or vessels for fluids: (1) the "vascular" system for blood; and (2) the "lymphatic" system for lymph fluid. The breast itself has small blood vessels and lymph vessels going through it. If they have the capability to do so, invasive breast cancer cells may break into a nearby lymph channel in the breast or into a nearby blood vessel in the breast, and may potentially travel elsewhere via the lymphatic system or bloodstream, respectively.

The pathologist looks at the lymph vessels and the blood vessels in the breast in the vicinity of the tumor for signs of lymphatic invasion (breaking into a lymph vessel) or vascular invasion (breaking into a blood vessel), and will note if present or observed. If they don't see signs of either of these in the sample, they may note "lymphovascular invasion" ("LVI") is not identified.

Clinical consensus guidelines for breast cancer focus on certain key pathologic criteria in connection with recommendations for systemic drug treatments (chemotherapy; HER2-targeted therapy (for HER2-positive disease); and/or endocrine therapy (for hormone receptor-positive disease (ER+ and/or PR+)):

--tumor histology (e.g., ductal, lobular, other);

--lymph node status;

--tumor size;

--hormone receptor status (ER, PR); and

--HER2 status.

Additional clinical (e.g., age, co-morbidities) and pathologic factors, such as grade and lymphovascular invasion (if present), may be considered in connection with systemic treatment decisions. However, as noted in a 2016 guideline from ASCO:

>>"In addition, in the opinion of the ASCO panel, factors such as grade 3 and the presence of lymphovascular invasion should generally not be used to drive decision making when considered in isolation and need to be interpreted in the overall clinical context."

Last but not least, in the appropriate case, the results of certain prognostic tests are also considered (e.g., the OncotypeDX test for invasive disease, used in certain cases of hormone receptor-positive and HER2-negative invasive breast cancer).

Please confirm it with your team, but "focal" suggests the LVI observed is limited in extent. The implications of this pathologic finding (if any) for systemic drug therapy in your particular case is a question for your Medical Oncologist, who will consider it in the overall clinical context (together with all relevant clinical and pathologic criteria).

BarredOwl

PamJ23

BarredOwl Thank you so much for all of the information. I've seen bits and pieces here and there but it always starts with predicting such a poor prognosis. Nothing ever really discusses if there is any difference in outcomes (statistically) between focal or extensive. It's just kind of all lumped together as one. Possibly this is something more common than is noted as a lot of patients may not notice it on their path reports. It was kind of just skipped over with me. Anyway, i appreciate your time and the info is really helpful. It's so hard not to have anxiety over all the different areas of this disease!

Pam

Kimhf

Hi: I asked this question on the wrong thread and was sent over here. Hope I'm on the right thread now. I had a lumpectomy on June 16. Everything came out clear - lymph nodes, margins. The cancer wasn't even a tumor but a collection of cells, 1/2 inch long. Yesterday at my post op appointment my surgeon told me I'm Stage 3 (aggressiveness). I completely flipped. I had no idea. She delivered this news with a nasty bedside manner. I haven't seen an oncologist yet. Have an appt. on Monday. Does anybody have anything positive to say about the Stage 1 but Grade 3? I'm completely filled with anxiety right now.

HaileysHooters

Hi all, I wanted to chime in as I've been discussing similar topics with my oncologists (I've gotten a couple of different opinions). Kimhf - did they say you're "stage 3" or "grade 3"?

My initial pathology report indicated I'm pT1c, N0 - Stage 1A (tumor was 1.8 cm), grade 2, node negative, with LVI "present". I went to another NCI-designated hospital and had my pathology re-ran, and they found the same as the above, though they declared me Grade 3, and said there were small traces of LVI. From what both hospitals have told me about LVI, they cannot distinguish if there are traces in the lymphatic system, or if there are traces in the vascular system. If it were in the lymphatic system, the fact that my lymphnodes that were removed during surgery were negative would mean that my cancer didn't spread. However, we can't safely say that is the case. One oncologist phrased it as "my system was breached."

My understanding of the Grades are based off an image one of the oncologists drew for me (I can upload it later once I'm able to scan it). She said Grade 1 cells very closely resemble normal breast cells, and it's very easy for a pathologist to know the cell came from the breast. Grade 2 cells still slightly resemble a normal breast cell, though it's more difficult for a pathologist to determine it came from the breast. Grade 3 cells lose the resemblance of a normal looking cell. When a pathologist looks at the cell, he can't determine if it came from the breast, lung, heart, ect.

The grade of a tumor is determined by measuring 1) architecture; 2) nuclear grade; and 3) mitotic rate. So the grade can differ depending on any of those variables.

Pam, it sounds like you and I may have a similar diagnosis depending on your hormone receptor status. I've recently received my oncotype results, which put me in a "gray zone." My new oncologist is putting in an order for the mammaprint test because we're unsure about the benefits of chemotherapy. Please share how your latest visit went!

Best of luck to all!

MinusTwo

Kim - there is a vast difference between Grade 3 and Stage 3.

I think I'm reading that you are Stage 1 Grade 3? Stage 1 is good. Did they say DCIS? Or it is IDC? Once you know the rest of your stats it will be easier to answer questions - like are you ER/PR positive; HER2 positive; etc.

It's very hard to wait. Try to keep you mind busy until Monday.