Immunohistochemical detection improves the prognostic value of lymphatic and blood vessel invasion in primary ductal breast cancer

BACKGROUND: Lymphovascular invasion (LBVI) including lymphatic (LVI) and blood (BVI) vessel invasion is a critical step in cancer metastasis. In breast cancer, the optimal detection method of LBVI remains unclear. This research aimed to compare the prognostic value of different assessments of the LVI and BVI in patients with early breast cancer. METHODS: The study cohort included 360 patients with a median follow-up of 168 months. LBVI on H&E sections (LBVI(H)&(E)) was reviewed centrally and blinded to the pathology report. Immunohistochemical staining for D2-40 and Factor VIII was performed to identify LVI(D2–40) and BVI(FVIII). RESULTS: LBVI(H)&(E), LVI(D2–40) and BVI(FVIII) were present in 102 (28%), 127 (35%) and 59 (16%) patients respectively. In node-negative patients (206), LBVI(H)&(E), LVI(D2–40) and BVI(FVIII) were present in 41 (20%), 53 (26%) and 21 (10%) respectively. In triple-negative patients (120), LBVI(H)&(E), LVI(D2–40) and BVI(FVIII) were present in 35 (29%), 46 (38%) and 16 (13%) respectively. LBVI(H)&(E) was significantly associated with tumour recurrence in the whole cohort (P < 0.001), node-negative patients (P = 0.001) and triple-negative patients (P = 0.004). LVI(D2–40) and BVI(FVIII) were significantly associated with tumour recurrence in whole cohort, node-negative (all P < 0.001) and triple-negative patients (P = 0.002). In multivariate survival analysis, only LVI(D2–40) and BVI(FVIII) were independent predictors of cancer specific survival in the whole cohort (P = 0.023 and P < 0.001 respectively), node-negative patients (P = 0.004 and P = 0.001 respectively) and triple-negative patients (P = 0.014 and P = 0.001 respectively). CONCLUSION: Assessment of LVI and BVI by IHC using D2-40 and Factor VIII improves prediction of outcome in patients with node-negative and triple-negative breast cancer.