Improved methods of detection of lymphovascular invasion demonstrate that it is the predominant method of vascular invasion in breast cancer and has important clinical consequences
Improved methods of detection of lymphovascular invasion demonstrate that it is the predominant method of vascular invasion in breast cancer and has important clinical consequences
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DOI：
10.1097/pas.0b013e31806841f6
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发表时间：
2007-12-01
影响因子：
5.6
通讯作者：
Ellis, Ian O.
中科院分区：
文献类型：
--
作者：
Mohammed, Rabab A. A.;Martin, Stewart G.;Ellis, Ian O.
乳腺癌中血管浸润（VI）的存在，包括淋巴血管浸润（LVI）和血管浸润（BVI），已被发现是一个预后不良的因素。然而，目前尚不清楚哪种VI在转移中起主要作用。本研究的目的是使用内皮亚型特异性免疫组织化学方法，通过比较血管（CD 34和CD 31）和淋巴标志物（podoplanin/D2-40）的差异表达来区分LVI和BVI，以确定其在已知长期随访的乳腺癌患者中的预后作用。对177例连续石蜡包埋的原发性浸润性乳腺癌存档标本的切片进行Podoplanin、D2-40、CD 31和CD 34的染色。确定BVI和LVI，结果与临床病理标准和患者生存率相关。在56/177份标本（31.6%）中检测到VI; 54份（96.4%）为LVI，2份（3.5%）为BVI。LVI的存在与淋巴结转移、肿瘤较大、远处转移、区域复发、无病期和总生存期差显著相关。在多变量分析中，LVI与无病间期缩短和总生存率显著相关。总之，乳腺癌的VI主要是淋巴管，是一个强大的独立预后因素，这与疾病的复发和死亡的风险。使用免疫组化染色与一个ependothelial特异性标记物，如podoplanin/D2-40增加了识别与肿瘤相关的LVI患者的准确性。
The presence of vascular invasion (VI), encompassing both lymphovascular invasion (LVI) and blood vascular invasion (BVI), in breast cancer has been found to be a poor prognostic factor. It is not clear, however, which type of VI plays the major role in metastasis. The aims of this study were to use an endothelial subtype specific immunohistochemical approach to distinguish between LVI and BVI by comparing the differential expression of blood vascular (CD34 and CD31) and lymphatic markers (podoplanin/D2-40) to determine their prognostic role in a well-characterized group of breast cancer patients with known long-term follow-up. Sections from177 consecutive paraffin-embedded archival specimens of primary invasive breast cancer were stained for expression of podoplanin, D2-40, CD31, and CD34. BVI and LVI were identified and results were correlated with clinicopathologic criteria and patient survival. VI was detected in 56/177 specimens (31.6%); 54 (96.4%) were LVI and 2 (3.5%) were BVI. The presence of LVI was significantly associated with the presence of lymph node metastasis, larger tumor size, development of distant metastasis, regional recurrence and worse disease-free interval and overall survival. In multivariate analysis, LVI retained significance association with decreased disease-free interval and overall survival. In conclusion, VI in breast cancer is predominantly of lymph vessels and is a powerful independent prognostic factor, which is associated with risk of recurrence and death from the disease. The use of immunohistochemical staining with a lymphendothelial specific marker such as podoplanin/D2-40 increases the accuracy of identification of patients with tumor associated LVI.