"Lymphovascular invasion is not identified"

Core needle biopsy does not test lymph nodes, that would be done with a sentinel node biopsy (SNB) during whatever type of surgery you end up having. The notation regarding lymphvaacular invasion is looking at whether this is present, or not present, in your core samples, "not identified" means you don't have it. Lymphvascular invasion occurs when cancer cells have broken into the vascular and lymphatic channels in the breast tissue. While it is certainly is better not to have LVI, its presence or absence is not reliably prognostic. Grade is part of what is pending in your biopsy pathology report, along with what your hormonal receptors and Her2 status is, and will partially indicate level of aggressiveness of the cancer.Stage is determined after surgery when the tumor is analyzed for size, final path report on hormonal receptors and Her2, and nodal status after SNB. Hope this is helpful, wishing you the best.

Actually, nodes are sometimes sampled by biopsy if there is reason to suspect involvement at time of diagnosis. My ultrasound showed enlarged nodes which were sampled and found to be malignant. I don't recall, however, whether the nodes were sampled by FNA or core biopsy, as opposed to the tumor which was definitely core biopsy.

Thanks for clarifying that, SK. I appreciate it and hope the OP found it helpful, too.

hester - yes, that is what the above posts indicated - no cancer found in the tissue or vessels of the breast - in the core samples submitted, but this has no direct bearing on whether there is cancer in the lymph nodes themselves. Sentinel node biopsy (SNB) is routinely done at the time of surgery, and the vast majority have SNB done simultaneously with breast surgery. A few have it done the day before, but that is their facility policy, and is not as common. Reflex to HERmark means that if your initial Her status testing is equivocal (not positive and not negative, as sometimes happens) then Hermark testing is requested - this is the reference to "reflex" - that is done when an additional test needs confirmation. I don't know if this means this is what is being requested IF you get an equivocal response, or you have gotten one and now the reflex testing is being done with that particular testing modality.

Dollydimples123:

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 has small blood vessels and lymph vessels going through it. Either system may be used by tumor cells to escape the breast.

If they have the capability to do so, cancer cells may break into a nearby lymph channel in the breast and travel through the lymph system to regional lymph nodes.

Cancer cells may also break into a local blood vessel and travel elsewhere via the bloodstream.

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

BarredOwl

LVI can be present in either biopsy samples and full tumor or breast tissue pathology samples - it was noted in both my biopsy pathology report and pathology report after BMX.

Dollydimples123:

Elsewhere you said you have invasive breast cancer. By definition, the tissue of the breast (stroma) has been invaded. Invasive disease (where cells have broken through the wall of the ducts or lobules into surrounding breast tissue) can occur without any lymphovascular invasion ("LVI").

Prior to your surgery, perhaps the absence of clinically suspicious nodes (no enlargement on clinical exam); the absence of evidence of LVI on breast biopsy (assuming vessels were seen in the biopsy sample); and normal imaging findings (regional lymph nodes seen were normal in appearance) means there was no basis to be suspicious of lymph node involvement. These are favorable findings, but are not conclusive and do not exclude the possibility of lymph node involvement. That is why a sentinel node biopsy was done.

They can use a radiotracer to find the sentinel node(s).

When your results are in, be sure to request complete copies of the pathology reports from all biopsies and surgeries, including any supplements or addenda thereto (e.g., containing ER, PR or HER2 testing) and review these yourself. Trust, but verify.

BarredOwl

Hi Dollydimples123:

It is hard to understand, particularly at first, when you have to learn so quickly and you are stressed (which did not aid comprehension for me).

Sometimes, with IDC where the tumor is greater than 0.5 cm in size, and ER+ PR+ HER2-, no LVI, and negative nodes (N0), chemotherapy may still be considered or recommended. This is because even sentinel node biopsy is not a perfect method, and there can still be some risk of undetected distant spread.

Tests such as the OncotypeDX test for invasive disease (for hormone receptor-positive, HER2-negative disease) or MammaPrint (more common in Europe) are sometimes used to obtain more information about estimated recurrence risk and help inform decision-making regarding whether to add chemotherapy to endocrine therapy (e.g., tamoxifen or an aromatase inhibitor) or not. Hopefully, you will have the opportunity to meet with a medical oncologist to discuss possible testing and options thoroughly prior to any further treatment.

Hoping for the best possible pathology results for you!

BarredOwl

As far as Dollydimples123 goes, she is still awaiting the results of surgical pathology and SNB. She has indicated her receptor statuses above (presumably based on biopsy) as "ER+ and PR+ and HER2-." I happen to know from another one of her posts that based on biopsy and imaging, she was diagnosed with an estimated " 1.1cm x 1.5cm and grade 2 invasive cancer".

BarredOwl

Hi Yorkiemom,

BarredOwl is right in that I have no details to list at the moment as I am awaiting my results.I will update as soon as I have these detais in.

I got a call from my BC nurse today to tell me that I was to go see the oncology department on Thursday about possibility of having chemo. However there are no results through even yet on my actual biopsy or SNB. My next question of course was how can you be thinking about chemo if you have not had results through...was told that it would just be good to see the doctor and find out and ask questions about this particular treatment. I got a vague feeling something was not right. Not sure if nurse had made some sort of mistake or was not too well versed on my details etc...seems strange to send me to a dept to speak about a treatment that I have not officially been told I am having yet. But maybe that is common procedure?

I was initially told I would most likely be getting lumpectomy, radiotherapy and Tamoxifen. When I asked about chemo last week, my BS said he didn't know for sure til op was done and result in from that. So this call was a little distressing and upsetting. Not because I am worried about having chemo, just that this was a shock I had not been prepared for fully.

I have a related question: my final path report post BMX says "not observed" for both vascular and lymphatic invasion. I don't see the Oncologist until Monday but I am wondering if it means they didn't see it (yay), OR they didn't test for it. I had a SNB that was clear before starting neoadjuvant chemo so maybe my samples weren't tested for LVI? I hope that is not the case since I still had 25% of my tumor left at surgery and who knows what that #$% was up to these past six months.

Thanks Barred Owl

I got my pathology results back today and am now am freaked out more.

35mm grade 2 IDC with prominent micropapillary component present.

Extensive Peritumoral lymphovascular invasion seen admixed intermediate grade DCIS present

ER8 PR6 HER2+

Resection margins 6mm from inferior >10mm all other margins

Extensive axillary disease present 18/22 nodes with extensive extra nodal spread evident.

All gross macroscopic disease was excised from axils at the of surgery.

Now on to chemo, herceptin plus radiotherapy and hormonal therapy.

Doesn't look good for this 52 year old body who had a clear mammography 21 August last year.

Anyone have any words of wisdom.

Thanks

Thank you BarredOwl I google too much which makes things even bleaker. The report I got wasn't great To look at in black and white.

I guess this is where we put our trust in the professionals and try not to get too phased out.

Another online friend has told me that this is a marathon and we are in in for the long haul.

Take care