Lymphvascular invasion

[tess528]

I am trying to get information regarding Lymphvascular Invasion as a prognostic factor.  My tumor was 8mm, Grade 1, ER+(99%)/PR-, HER2Neu-, no necrosis, and all of my nodes were negative via axillary dissection.  I had a bilateral mastectomy w/immediate tram reconstruction.  The only negative on my pathology report was lymphvascular invasion being present.  One oncologist said it didn't really "fit" with the rest of my pathology.  I am in the middle of having CMFx8 followed by Tamoxifen + Lupron shots.  I probably would have been this aggressive without the LVI as I lost my mom and grandmother to breast cancer, but the LVI is really making me nervous.   I know that historically node status is the most important followed by tumor size and grade/markers but I've read one or two studies that placed much more emphasis on LVI.  Should I be treated as if I have positive lymphnodes or is LVI actually worse than positive nodes?  I also wonder whether a second pathology opinion might show no invasion since that is more subjective than other factors.  All of the oncologists including Sloan Kettering said it is very curable with a 10% chance of recurrance but as you can tell, the LVI is really making me question them and that recurrance rate.

I am also 30 years old which is another reason they are treating me aggressively.  

Thanks,
Teresa

[CCF-RN,MSN-JS]

Dear Teresa, The problem with lymphovascular invasion being used as a prognostic factor, is that in some of the studies it has been reported as being an important factor, however in other studies this has not been the case.  What the information about prognostic factors does is to help us in making treatment recommendations.  So in your case, even if we err on the side of this finding (+ LVI)increasing the likelihood of recurrence, you are already receiving adjuvant treatment, both with chemotherapy as well as hormone therapy.  There would not need to be any adjustment at this point to the treatment plan.

[surgeon]

It's true it's nice not to see LVI; however, it seems you are being treated as aggressively as if you had had nodal involvement. Even without LVI, there's never a way to be absolutely sure of cure, which is one of the great shortcomings of our current state of cancer treatment. But you should be pretty confident: you had a very favorable set of data, and have gone all the way with treatment. The outcome ought to be good!!