Lack of emphasis on vascular invasion

Its so strange how one Onc says one thing and another says different thing.  My Onc even stressed that I strongly think about chemo since I had extensive LIV and the 3 nodes they took out had mets in them.  I am still confused at the whole deal and I have finished treatment. 

i was node-positive, Grade 3 and LVI. I thought I was doomed, but my ONC just insisted that these factors made chemo a great treatment for me. I opted for a BMX and still ended up with rads too. Now I take Tamoxifen and will switch to an AI in 5 years. So . . . I've pretty much thrown the kitchen sink at this crap. Strangely enough my ONC never mentioned LVI. I read about it on the pathology report. The positive nodes were what dictated the aggressive treatment plan.

LtotheK,  So true, that not all Grade 3's are equal or behave the same way.  I have also heard the higher Stages, with their more aggressive treatments, sometimes fare better than an earlier Stage that hasn't been treated as aggressively.

Whether your path. report says "LVI" or not, if you have positive nodes, your lymph system has been invaded; therefore, if the path report say something like 2/5 nodes positive, it is not really necessary to also include the phrase LVI.  However, there could be instances where the nodes check out clear, but LVI is detected in the tumor sample under the microscope.  Then what?  That's a gray area. 

LVI was on my path report and it really freaked me out. My MO never mentioned it at all and when I asked the RO  he didn't seem that concerned about it. He was more concerned about the positive nodes and I also had extracapsular extension. I just hope that all the chemo I had and then radiation took care of it all.

elimar...  BMX, 20 rads, plus Arimidex  (still on it )

withlove,

I have asked EVERY doctor I've seen about the biopsy showing LVI and I could never really get a satisfying answer.  From what I was told though, was that probably the LVI was very tiny and it is even possible that the only area of LVI was in the exact place that it was biopsied.  Another onc explained it to me that when they check tissue removed they can't check every little area. They slice it and do "samplings."  A "sampling" they checked at biopsy had LVI, the "samplings" they checked after mastectomy did not.  He said that's a good thing because it means the LVI was minimal.  My first onc said that she suspects that many, many more women have LVI than is found and reported because of this same thing--if it is minimal, the sampling might miss it.  All doctors said, though, that I have to go by the biopsy findings--if LVI was seen, it was there. That is something that is real--someone looked through a microscope and saw it.  I guess we have to take a little relief in that it must have been minimal.

Anyone else know anymore about this?

This study has floated around quite a bit on these boards, it is an excellent one:  http://jnci.oxfordjournals.org/content/101/10/729.full

Basically, the findings are, if you are high risk for recurrence, the LVI seems to have independent prognostic factors.  If at low risk, it is not an independent prognostic factor for recurrence.

Generally speaking, this is so totally out of our control that it's probably best to know what we know (which is more than so many patients), and go have a nice day.  Yeah, it freaks me...

The question of having clear nodes, yet showing LVI on any pathology is still an interesting topic that we have not heard all that much about.

Elimar, the study I posted addresses that point exactly.  It appears if one does not have other risk factors, the LVI is not a stand-alone risk factor.  Now, in my case, I'm all over the place.  Grade 3, low oncotype, fairly young at diagnosis, but not too young according to what was considered an additional risk factor.

It's interesting to me how many of us really fall in a huge grey zone.  So very hard to know what to do.  In any case, after reviewing this thread, and hearing multiple opinions, I'm very glad I opted for chemo.  My case is really wiggly.