Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar 21;11(3):968.
doi: 10.3390/biomedicines11030968.

Updates on Lymphovascular Invasion in Breast Cancer

Elisabetta Kuhn  1   2 , Donatella Gambini  3 , Luca Despini  4 , Dario Asnaghi  5 , Letterio Runza  2 , Stefano Ferrero  1   2
Affiliations
Review

Updates on Lymphovascular Invasion in Breast Cancer

Elisabetta Kuhn et al. Biomedicines. .

Abstract

Traditionally, lymphovascular invasion (LVI) has represented one of the foremost pathological features of malignancy and has been associated with a worse prognosis in different cancers, including breast carcinoma. According to the most updated reporting protocols, the assessment of LVI is required in the pathology report of breast cancer surgical specimens. Importantly, strict histological criteria should be followed for LVI assessment, which nevertheless is encumbered by inconsistency in interpretation among pathologists, leading to significant interobserver variability and scarce reproducibility. Current guidelines for breast cancer indicate biological factors as the main determinants of oncological and radiation therapy, together with TNM staging and age. In clinical practice, the widespread use of genomic assays as a decision-making tool for hormone receptor-positive, HER2-negative breast cancer and the subsequent availability of a reliable prognostic predictor have likely scaled back interest in LVI's predictive value. However, in selected cases, the presence of LVI impacts adjuvant therapy. This review summarizes current knowledge on LVI in breast cancer with regard to definition, histopathological assessment, its biological understanding, clinicopathological association, and therapeutic implications.

Keywords: LVI; angioinvasion; breast cancer; breast carcinoma; lymphovascular invasion; prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Representative pictures of an LVI tumor embolus (arrow) walled by an endothelial cell layer positive for CD31, CD34, and D2-40 immunostaining. p63 shows the absence of myoepithelial cells (200× magnification).
Figure 2
Figure 2
LVI (arrow) adjacent to a non-neoplastic lobule (l) and a small duct (d). The immunohistochemical staining demonstrates an endothelial layer (CD31+, CD34−, D2-40+, and p63−) surrounding the LVI embolus. Both the l and d show an irregular positivity for CD31, CD34, and faint D2-40 that can simulate LVI, particularly in small structures like d; however, positivity for p63 identifies myoepithelial cells of the terminal duct-lobular unit (200× magnification).
See this image and copyright information in PMC

References

    1. Mohammed R.A., Martin S.G., Mahmmod A.M., Macmillan R.D., Green A.R., Paish E.C., Ellis I.O. Objective assessment of lymphatic and blood vascular invasion in lymph node-negative breast carcinoma: Findings from a large case series with long-term follow-up. J. Pathol. 2011;223:358–365. doi: 10.1002/path.2810. - DOI - PubMed
    1. Torous V.F., Simpson R.W., Balani J.P., Baras A.S., Berman M.A., Birdsong G.G., Giannico G.A., Paner G.P., Pettus J.R., Sessions Z., et al. College of American Pathologists Cancer Protocols: From Optimizing Cancer Patient Care to Facilitating Interoperable Reporting and Downstream Data Use. JCO Clin. Cancer Inf. 2021;5:47–55. doi: 10.1200/CCI.20.00104. - DOI - PMC - PubMed
    1. Modi A.P., Nguyen J.P.T., Wang J., Ahn J.S., Libling W.A., Klein J.M., Mazumder P., Barsky S.H. Geometric tumor embolic budding characterizes inflammatory breast cancer. Breast Cancer Res. Treat. 2023;197:461–478. doi: 10.1007/s10549-022-06819-6. - DOI - PMC - PubMed
    1. Fitzgibbons P., Connolly J., Bose S. Protocol for the examination of resection specimens from patients with invasive carcinoma of the breast. Coll. Am. Pathol. 2020;4:1515–1538. - PubMed
    1. Goldhirsch A., Wood W.C., Coates A.S., Gelber R.D., Thürlimann B., Senn H.J., Panel members Strategies for subtypes—Dealing with the diversity of breast cancer: Highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann. Oncol. 2011;22:1736–1747. doi: 10.1093/annonc/mdr304. - DOI - PMC - PubMed