Increased detection of lymphatic vessel invasion by D2-40 (podoplanin) in early breast cancer: possible influence on patient selection for accelerated partial breast irradiation.
OBJECTIVE
Several international trials are currently investigating accelerated partial breast irradiation (APBI) for patients with early-stage breast cancer. According to existing guidelines, patients with lymphatic vessel invasion (LVI) do not qualify for APBI. D2-40 (podoplanin) significantly increases the frequency of LVI detection compared with conventional hematoxylin and eosin (HE) staining in early-stage breast cancer. Our purpose was to retrospectively assess the hypothetical change in management from APBI to whole breast radiotherapy with the application of D2-40.


METHODS
Immunostaining with D2-40 was performed on 254 invasive breast tumors of 247 patients. The following criteria were used to determine the eligibility for APBI: invasive ductal adenocarcinoma of < or =3 cm, negative axillary node status (N0), and unifocal disease. Of the 247 patients, 74 with available information concerning LVI, as detected by D2-40 immunostaining and routine HE staining, formed our study population.


RESULTS
Using D2-40, our results demonstrated a significantly greater detection rate (p = .031) of LVI compared with routine HE staining. LVI was correctly identified by D2-40 (D2-40-positive LVI) in 10 (13.5%) of 74 tumors. On routine HE staining, 4 tumors (5.4%) were classified as HE-positive LVI. Doublestaining of these specimens with D2-40 unmasked false-positive LVI status in 2 (50%) of the 4 tumors. According to the current recommendations for APBI, immunostaining with D2-40 would have changed the clinical management from APBI to whole breast radiotherapy in 8 (10.8%) of 74 patients and from whole breast radiotherapy to APBI in 2 patients (2.7%).


CONCLUSIONS
These data support the implementation of D2-40 immunostaining in the routine workup to determine a patient's eligibility for APBI.
Department of Obstetrics and Gynecology, University of Bonn, Bonn, Germany. debald@uni-bonn.de
Manuel
M
Debald
Martin
M
Pölcher
Uta
U
Flucke
Gisela
G
Walgenbach-Brünagel
Klaus-Jürgen
KJ
Walgenbach
Tobias
T
Höller
Matthias
M
Wolfgarten
Christian
C
Rudlowski
Reinhard
R
Büttner
Hans
H
Schild
Walther
W
Kuhn
Michael
M
Braun
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D042601:Lymphatic Vessels / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013194:Staining and Labeling / Q000379:methods; D014916:Whole-Body Irradiation / Q000379:methods
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40