Angiolymphatic Invasion Presence

I think it's because that - while circulating tumor cells have been discovered - they haven't "lodged" anywhere yet and begun to form a secondary (i.e., metastastic) cancer.  Until distant metastasis has been confirmed, then they don't consider you a Stage IV. 

I think.

Alot of emphasis is put on staging and lymph node status because these things are important in determining the nature- and personality of your cancer, i.e., is it invasive?  How aggressive is it?  What does it use to fuel itself?  Personally, I feel that lymphovascular invasion is an important part of breast cancers' "personality", but I keep reading past posts on this board from women whose doctors didn't give them this important piece of information for whatever reason.  I'm not sure why. 

I know that LVI is a crucial prognostic factor for some cancers, so I made the assumption that it was important to breast cancer too.  However, I've read conflicting articles as to whether the presence of LVI has prognostic value - or not - in breast cancer.  Unfortunately, all the articles, I've found are not current and I haven't been able to locate anything more recent than 2005-2006.

It's a very interesting question. Even on this board, we're not given an option for LVI status on our diagnosis. 

Scary...so we're doomed if we have LVI. Oh Lord, up goes the anxiety level. I have worried about the lymphovascular invasion, but then again, I know two ladies who had BC with LOTS of positive nodes -  one in 1984 and one who never gave me a year but said she was in her forties (she's at least 80 now) - who are fine now. Is it possible to have lots of nodes and no LVI?

But is it possible for someone to have a huge tumor and lots of nodes without having LVI? Just curious because I don't know of anyone who has. But then again, a lot of the folks I know, we've never talked about whether they had LVI, so maybe that it possible. Just wondering. Never thought about it before.

Wow something i have asked my oncologist but told me no need to worry. Im.am going to read on but had to quickly reply because i always thought the same

Hi,

I had LVI along with  micromet to the nodes when i was diagnosed.  It added chemo to my treatment mix (lumpectomy, radiation and hormone treatment were already planned.)  I'm three years out from diagnosis so far  mammo and blood work are all looking good.

Because LVI is present, does not automatically mean it will settle and grow.  Of course, it may, and show up months or years later; however, stray cancer cells traveling in the blood stream does not in itself mean that you will recur as your immune system and other cancer fighting cells can also kill them off, or they also can just die off on their own.  It's when they begin to join their own army and clump together and then begin to replicate and claim a territory as their "battlefield" - that the problem then arises.  I think that is why most onc's don't worry about it when all other scans appear clear at diagnose, as we all have cancer cells from time to time that our bodies fight off and they die.  Hope this helps a bit.

I don't think being inoperable and systemic is the key to stage 4.

The key is mets to a distant organ.  

Someone who has liver mets and has a resection, is still stage 4, eventhough their cancer is operable. 

As someone else said, many early stage could have cancer cells in their blood, but until it invades a distant organ, you are early stage.

Laurie

As kayb said so beautifully... circulating cancer cells (CTC's) do not always equate to metastatic disease and, since oncologists can't predict which ones will- or won't, they use CTC counts and the presence of LVI/ALI as part of the whole process of determining treatment not staging.

They also mention it if it is NOT found. My path report said no LVI noted.

So did mine, although I did have a positive sentinal node.  So my tumor was sloughing off cells that travelled through the tissue to "infect" the (very) nearby sentinal node, but had not induced blood/lymph vessel growth to directly tap into my lymphatic- and vascular systems.  As a result, my axillary nodes were clear.

 Here's the current research on LVI:

The prognostic significance of lymphovascular invasion in invasive breast carcinoma.

Authors

Journal

Cancer. 2011 Dec 16. doi: 10.1002/cncr.26711. [Epub ahead of print]

Affiliation

Department of Histopathology, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom. emadrakha@yahoo.com.

Abstract

BACKGROUND: Although lymphovascular invasion (LVI) has been associated with a poor outcome in patients with breast cancer, it is not included in most internationally recognized staging systems, including the American Joint Committee on Cancer tumor, lymph node, metastasis (TNM) classification. This is mainly because it remains unclear whether the presence of LVI is an independent, high-risk criterion in clinically relevant staging subgroups.

METHODS: The current study was based on a large and well characterized consecutive series of patients who had operable (pathologic T1 [pT1]-pT2, pathologic N0 [pN0]-pN3, M0) breast cancer (3812 informative cases) who were treated according to standard protocols at a single institution and who had long-term follow-up to assess the prognostic value of definite LVI in clinically and molecularly relevant staging subgroups.

RESULTS: LVI was strongly associated with both breast cancer-specific survival (BCSS) and distant metastasis-free survival (DMFS) in the entire series and in different subgroups. Multivariate analyses identified LVI as an independent predictor of both BCSS and DMFS in patients with operable breast cancer overall; in the TNM clinical subgroups pT1a-pT1c/pN0 and pT2/pN0; and in the molecular classes estrogen receptor (ER)-positive, ER-negative, human epidermal growth factor 2 [HER2]-negative, and triple-negative. In patients who had lymph node-negative tumors, LVI could be used as a high-risk criterion providing survival disadvantage equivalent to that provided by 1 or 2 involved lymph nodes (pN0 to pN1) and to that provided by 1 size category (pT1 to pT2). The use of immunohistochemistry for detecting an endothelial-specific marker contributed to the prognostic significance of LVI when applied to routine LVI negative/possible cases.

CONCLUSIONS: LVI provided a strong predictor of outcome in patients with invasive breast cancer and should be incorporated into breast cancer staging systems. Cancer 2012;. © 2011 American Cancer Society.

PMID

22180017 [PubMed - as supplied by publisher]Full text: John Wiley & Sons, Inc.

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The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer.

Authors

Song YJ,et al. Show allSong YJ, Shin SH, Cho JS, Park MH, Yoon JH, Jegal YJ.

Journal

J Breast Cancer. 2011 Sep;14(3):198-203. Epub  2011 Sep 29.

Affiliation

Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.

Abstract

PURPOSE: Lymphovascular invasion (LVI) is an important prognostic factor in patients with lymph node-negative patients with invasive breast cancer. However, the prognostic value of LVI it is unclear and controversial about its prognostic value in patients with lymph node-positive breast cancer patients. So, we report the an analysis of the prognostic significance of LVI in a large cohort study of patients with lymph node-positive patients with invasive breast cancer.

METHODS: We retrospectively reviewed 967 patients with invasive breast cancer that had undergone surgical treatment at our hospital, from January 2004 to December 2007. Among these thempatients, 349 patients with lymph node-positive breast cancer patients are were included in this study. We evaluated clinical and pathological data in these patients, we compared with 5-year overall survival and disease-free survival between an LVI-present group and an LVI-absent group.

RESULTS: The median follow-up was 48 months (range, 12-78 months), and the mean age of the patients was 48 years (range, 23-78 years). LVI was present in 192 patients (55%) of with tumors and was associated with age ≤40 years (p=0.009), high histologichistological grade (p=0.007), estrogen receptor status (p=0.001), tumor size ≥2 cm (p<0.001), and number of involved lymph nodes (p<0.001), but not with progesterone receptor status, HER2 status, p53 status, or tumor multiplicity. LVI was a significant independent prognostic factor for disease-free survival (p<0.001) and overall survival (p=0.006). By multivariate analysis revealed that LVI (p=0.003), number of involved lymph nodes (≥4; p=0.005), and high histological grade (II and III; p=0.02) was were an independent significant predictors of disease-free survival and overall survival in the whole group of patients.

CONCLUSION: In this case, we demonstrated that LVI is a significant predictor of poor prognosis in patients with lymph node-positive patients with primary invasive breast cancer, LVI is a significant predictive predictor value of poor prognosis. So, LVI should be considered in the therapeutic strategy as a decision making tool in the adjuvant chemotherapy setting.

PMID

22031801 [PubMed]

PMCID

PMC3200515 Free Full TextFree full text: Korean Breast Cancer Society

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Ann Surg Oncol. 2009 Oct;16(10):2705-10. Epub  2009 Jul 11.

Presenting features of breast cancer differ by molecular subtype.

Wiechmann L, Sampson M, Stempel M, Jacks LM, Patil SM, King T, Morrow M.

Source

Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

Abstract

BACKGROUND:

Gene expression profiling of breast cancers identifies distinct molecular subtypes that affect prognosis. Our goal was to determine whether presenting features of tumors differ among molecular subtypes.

METHODS:

Subtypes were classified by immunohistochemical surrogates as luminal A (estrogen receptor [ER] and/or progesterone receptor [PR] positive, HER-2-), luminal B (ER and/or PR+, HER-2+), HER-2 (ER and PR-, HER-2+), or basal (ER, PR, HER-2-). Data were obtained from an established, registered database of patients with invasive breast cancer treated at our institution between January 1998 and June 2007. A total of 6,072 tumors were classifiable into molecular subtypes. The chi(2) test, analysis of variance, and multivariate logistic regression analysis were used to determine associations between subtype and clinicopathologic variables.

RESULTS:

The distribution of subtypes was luminal A, 71%; luminal B, 8%; HER-2, 6%; and basal, 15%. Marked differences in age, tumor size, extent of lymph node involvement, nuclear grade, multicentric/multifocal disease, lymphovascular invasion (LVI), and extensive intraductal component were observed among subtypes. When compared with luminal A tumors, those overexpressing HER-2 (luminal B, HER-2) were significantly more likely to manifest nodal involvement, multifocal, extensive intraductal component, and LVI (P < 0.0001). On multivariate analysis, after controlling for patient age, tumor size, LVI, and nuclear grade, HER-2 subtype tumors were 2.0 times more likely to have four or more metastatic lymph nodes (P < 0.0001) and 1.6 times more likely to have multifocal disease (P < 0.0001) compared with patients with luminal A.

CONCLUSIONS:

Tumor presentation varies among molecular subtypes; this information may be useful in selecting local therapy. Neoadjuvant therapy and lymph nodes evaluation before surgery or neoadjuvant therapy are likely to be beneficial in HER-2-overexpressing tumors.

PMID:

19593632

[PubMed - indexed for MEDLINE]