title: D2-40 in breast cancer: should we detect more vascular emboli?
abstract: Peritumoral emboli assessed on hematoxylin-eosin-stained slides are taken into account for treatment of patients with operable breast cancer. We assessed whether immunostaining with D2-40 improves the prognostic significance of emboli in a group of tumors with a large immunohistochemical sampling and a long-term follow-up. Topography, number, and extension of hematoxylin-eosin and D2-40 emboli were compared in 94 node-negative breast cancers (median number of immunostained slides per tumor: 3). Metastasis-free survival of patients with or without hematoxylin-eosin and/or D2-40 emboli were evaluated (median follow-up of 178 months). Hematoxylin-eosin emboli were detected in 14 (15%) tumors and were located at distance from the tumor. D2-40 emboli were detected in 39 (41%) tumors and was often multiple (n=30), extensive (n=23), located within (n=13), close to (n=10) or at distance from the tumor (n=16). The 12 distant hematoxylin-eosin and D2-40 emboli were located in the same vessels (seven missed at the first hematoxylin-eosin examination and secondarily diagnosed by D2-40 staining). A difference in metastasis-free survival was found only between patients with no D2-40 emboli and those with distant D2-40 emboli (P=0.02). D2-40 emboli located within or close to the tumor had no prognostic value. Comparing the metastasis-free survival of patients with or without hematoxylin-eosin emboli, the prognostically unfavorable significance of hematoxylin-eosin emboli was improved when taking into account the seven patients with missed emboli at the first examination and secondarily diagnosed by D2-40 staining (P=0.006 vs 0.003). To conclude, D2-40 increases the diagnostic sensitivity of emboli in breast carcinoma and the high incidence of D2-40 emboli might be related to the number of immunostained slides per case. Nevertheless, only distant D2-40+ emboli had a prognostic impact. In practice, D2-40 might be useful to detect missed hematoxylin-eosin emboli especially in cases without any other prognostically unfavorable criterion.
authors.affiliation: Department of Pathology, Institut Bergonié, Regional Cancer Center, Bordeaux, France. mascarel@bergonie.org
authors.forename: Isabelle
authors.initials: I
authors.lastname: de Mascarel
authors.forename: Gaëtan
authors.initials: G
authors.lastname: MacGrogan
authors.forename: Marc
authors.initials: M
authors.lastname: Debled
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Sierankowski
authors.forename: Véronique
authors.initials: V
authors.lastname: Brouste
authors.forename: Simone
authors.initials: S
authors.lastname: Mathoulin-Pélissier
authors.forename: Louis
authors.initials: L
authors.lastname: Mauriac
mesh_terms: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000032:analysis*; D001808:Blood Vessels / Q000276:immunology / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000628:therapy; D002277:Carcinoma / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000628:therapy; D004396:Coloring Agents; D004617:Embolism / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D004801:Eosine Yellowish-(YS); D005188:False Negative Reactions; D005260:Female; D006416:Hematoxylin; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000276:immunology / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009360:Neoplastic Cells, Circulating / Q000276:immunology / Q000473:pathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013194:Staining and Labeling / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D015295:Antigens, Tumor-Associated, Carbohydrate; D004396:Coloring Agents; C500987:monoclonal antibody D2-40; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin