Stage I, grade I, but with LVI. Chemo yes or no?

Husband/ caregiver here...

Fwiw, my wife's Onc said that LVI was 'another risk factor' and that patients with negative node disease who might not otherwise be doing chemo could be recommended to do chemo if they had LVI.

There does not seem to be a ton of information out there on LVI.

This, to me, is another example of the frustrating nature of the treatment decision process with breast cancer.

Why isn't there more of a definitive conclusion on the significance of LVI?

Could LVI go unnoticed in patients?

Have people with LVI not gotten treatment they possibly could have benefitted from as a result?

My wife is 41 and had 1 positive node. Chemo was recommended based largely on this---and our 2nd opinion was at MSK.

Her initial pathology said 'LVI: not present', but then another pathologist looked at the slides and wrote: 'few foci suspicious for LVI'.... What the heck is THAT? Is it LVI or not? What a cop out. It's exasperating. Our decision was made irrespective of this 'suspicious' LVI----but what kind of decision were we supposed to make if she had no positive nodes? Do chemo because 'few foci were suspicious for LVI'?

When the significance of LVI hasn't even been clearly defined?

I supposed we would have pushed for the Oncotype Dx if no nodes were positive... but even then, is Oncotype Dx validated for LVI?

Does anyone even know?

In our case, the expert basically said: "you MIGHT have this. I'm not saying you DO. You MIGHT. Regardless, we don't even know the ramifications if you DO have it." Oy! Thanks for NOTHING, Ms. Pathologist! How is anyone supposed to make a decsion based on this sketchy information? But we were doing chemo anyway.

YOUR case is less clear. I'd get the Oncotype Dx, then ask your Onc to review all of your factors with you again. I know I'm not really helping you as much as I am commiserating with you regarding the gravity of the decision you must make without the facts being nearly clear enough for comfort. Best of luck with all of this.

I feel your pain on the lack of information on LVI.  I did not have LVI after core biopsy but had it after the tumor was removed.  I did do oncotype and my score was 17.  I was 45 years old at diagnosis with a 4 year old son.  I got two opinions-one said no chemo and the other thought I could benefit from chemo.  I was initially diagnosed as grade 1 but then they changed the diagnosis to grade 2 because some cells appeared more like grade 2.  I had to make the decision on the chemo myself.  The main reason I did chemo was because of LVI...it scared me because nothing I read was good about it.  I did TCx4 for chemo and was done in 9 weeks.  I used cold caps to keep my hair.  I am glad I did the chemo.  I can look back knowing I did everything possible to fight this.  Good luck with your decision......I know how hard it is!

One way that LVI was explained to me was "there is an established path that cancer could have spread by blood".  When described this way, it sounded no different than having a positive node in my mind....that was just my thought.  Clearly there is nothing that really shows that....It just pushed me to do chemo.  Everyone has to think about things for their own personal situation and make a decision about what is right for them personally.  There is no one right answer.  For me my young son and being in excellent health (other than BC) pushed me to opt for the chemo.  I don't know if it helped me or not...I will never know. I do know that I could not face my son if I refused chemo and the BC came back.  If the BC comes back (knowing that I did do the chemo), I will not have regret...I will know I did everything I could to kick this.   I too was very frustrated by the lack of studies and clinical information available on LVI. My one surgeon said that there is potential that LVI could even be caused by the biopsy.....I sure hope not! I wish I could offer more information to you gals on LVI...but I can't. 

@SylviaT: interesting article. I wonder if "few foci suspicious" on a path report is considered extensive, intermediate, focal or what in this study.



I know some paths include the word "extensive" when it is.



My wife's said "not present" on 1 path report and "few foci suspicious" on another.

I'm having a tumor board look at my case and ONC called yesterday to say that the pathologist is concerned about LVI. Would love to look at that link SylviaT, but it's not working :-( Waiting for these experts to figure it out, no fun...

My oncotype is 20. I was diagnosed at 47. Polled and read and researched. My MO said it gives him pause. Another oncologist said do it. My Surgeon said stats say don't do it however she is biased because she has a patient my age similar score with LVI and there was a recurrence. She told me if I were her sister she would tell her do it.

I am not directing anyone..I just struggled with this decision and in the end I wasn't comfortable with the LVI

Focal vs extensive makes the difference. Small grade 1 tumours can be sneaky if they are Her2+ or triple negative. and they do oncotyype DX tests to find out if your tumour has the potential to metastasize. With such strong hormones, I think the antihormonals will do you nicely. I never got the oncotypeDX either, despite a grade 3. But it was small. Node negative. H+. So that is all favourable. I hope. We all worry across the board about recurrence, especially mets and they can and do happen to us hormone + ladies YEARS down the road. But what the heck. Something else can take us out too, so why worry. Worry never stopped my second cancer so live life as it comes to you!!!