Abstract
Breast cancer is a major health problem in the world. It is a disease with significant morbidity and mortality. Metastasis and recurrence are the main causes of mortality in breast carcinoma. Lymphovascular invasion is associated with increased axillary node metastasis and recurrence. Identifying lymphovascular invasion (LVI) is difficult in haematoxylin and eosin stained slides especially if lumen is completely filled by tumour cells or when retraction artefacts is present. D2-40 is a sensitive and specific marker to detect tumour cells in lymphatic vessels. It selectively and specifically stains lymphatic endothelial cells. CD31 is a 130 kDa transmembrane glycoprotein in the immunoglobulin super family. CD31 stains blood and lymph vessels. Staining with these immunomarkers makes it easy to identify the invasion. If it is identified more aggressive therapy can be given to the patient which will reduce the recurrence rate in carcinoma breast patients.
Keywords: Lymphatic invasion, blood vessel invasion, Carcinoma breast, D2-40, CD 31, metastasis.
References
- Marinho VF, Sanches FS, Rocha GF, Metze K, Gobbi H. D2-40, a novel lymphatic endothelial marker: identification of lymphovascular invasion and relationship with axillary metastases in breast cancer. Jornal Brasileiro de Patologia e Medicina Laboratorial. 2008 Feb;44(1):45-50.
- Arnaout-Alkarain A, Kahn HJ, Narod SA, Sun PA, Marks AN. Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer. Modern pathology. 2007 Feb 1;20(2):183-91.
- Van den Eynden GG, Van der Auwera I, Van Laere SJ, Colpaert CG, van Dam P, Dirix LY, Vermeulen PB, Van Marck EA. Distinguishing blood and lymph vessel invasion in breast cancer: a prospective immunohistochemical study. British journal of cancer. 2006 Jun 5;94(11):1643-9.
- Britto AV, Schenka AA, Moraes-Schenka NG, Alvarenga M, Shinzato JY, Vassallo J, Ward LS. Immunostaining with D2–40 improves evaluation of lymphovascular invasion, but may not predict sentinel lymph node status in early breast cancer. BMC cancer. 2009 Apr 8;9(1):109.
- Rakha EA, Martin S, Lee AH, Morgan D, Pharoah PD, Hodi Z, MacMillan D, Ellis IO. The prognostic significance of lymphovascular invasion in invasive breast carcinoma. Cancer. 2012 Aug 1;118(15):3670-80.
- Dekker TJ, Van de Velde CJ, Van Bruggen D, Mesker WE, Van der Hoeven JJ, Kroep JR, Tollenaar RA, Smit VT. Quantitative assessment of lymph vascular space invasion (LVSI) provides important prognostic information in node-negative breast cancer. Annals of oncology. 2013 Oct 10;24(12):2994-8.
- Wahal SP, Goel MM, Mehrotra R. Lymphatic vessel assessment by podoplanin (D2-40) immunohistochemistry in breast cancer. Journal of cancer research and therapeutics. 2015 Oct 1;11(4):798.
- Song YJ, Shin SH, Cho JS, Park MH, Yoon JH, Jegal YJ. The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer. Journal of breast cancer. 2011 Sep 1;14(3):198-203
- Mohammed ZM, McMillan DC, Edwards J, Mallon E, Doughty JC, Orange C, Going JJ. The relationship between lymphovascular invasion and angiogenesis, hormone receptors, cell proliferation and survival in patients with primary operable invasive ductal breast cancer. BMC clinical pathology. 2013 Nov 25;13(1):31.
- Tezuka K, Onoda N, Takashima T, Takagaki K, Ishikawa T, Wakasa T, Wakasa K, Hirakawa K. Prognostic significance of lymphovascular invasion diagnosed by lymphatic endothelium immunostaining in breast cancer patients. Oncology reports. 2007 May 1;17(5):997-1003.
- Lee JA, Bae JW, Woo SU, Kim H, Kim CH. D2-40, podoplanin, and CD31 as a prognostic predictor in invasive ductal carcinomas of the breast. Journal of breast cancer. 2011 Jun 1;14(2):104-11.
- Shen S, Zhong S, Lu H, Huang W, Xiao G. A Meta-Analysis of Lymphatic Vessel Invasion Correlated with Pathologic Factors in Invasive Breast Cancer. Journal of Cancer Therapy. 2015 Apr 2;6(04):315.
- Marinho VF, Metze K, Sanches FS, Rocha GF, Gobbi H. Lymph vascular invasion in invasive mammary carcinomas identified by the endothelial lymphatic marker D2-40 is associated with other indicators of poor prognosis. BMC cancer. 2008 Feb 29;8(1):64.
- Mohammed RA, Menon S, Martin SG, Green AR, Paish EC, Ellis IO. Prognostic significance of lymphatic invasion in lymph node-positive breast carcinoma: findings from a large case series with long-term follow-up using immunohistochemical endothelial marker. Modern Pathology. 2014 Dec 1;27(12):1568-77.
- Kato T, Kameoka S, Kimura T, Nishikawa T, Kobayashi M. The combination of angiogenesis and blood vessel invasion as a prognostic indicator in primary breast cancer. British journal of cancer. 2003 Jun 16;88(12):1900-8.
- Gujam FJ, Going JJ, Mohammed ZM, Orange C, Edwards J, McMillan DC. Immunohistochemical detection improves the prognostic value of lymphatic and blood vessel invasion in primary ductal breast cancer. BMC cancer. 2014 Sep 18;14(1):676.
- Laser J, Cangiarella J, Singh B, Melamed J, Chiriboga L, Yee H, Darvishian F. Invasive lobular carcinoma of the breast: role of endothelial lymphatic marker D2-40. Annals of Clinical & Laboratory Science. 2008 Mar 20;38(2):99-104.
Corresponding Author
Prasad P H
Professor, Department of Pathology
Govt. Medical College, Thrissur, Kerala, India
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