title: Impact of the prognostic value of vascular invasion, but not lymphatic invasion, of the primary tumor in patients with breast cancer.
abstract: BACKGROUND
  The prognostic value of lymphovascular invasion (LVI) in patients with breast cancer is unclear. Lymphatic invasion may mainly represent the selective affinity of breast cancer cells for lymph nodes. This study was undertaken to evaluate the presence of vascular invasion that may reflect systemic disease as a predictor of disease recurrence in breast cancer, separate from lymphatic invasion of the primary tumor.
  
  
  METHODS
  We retrospectively evaluated the cases of 263 consecutive female patients with primary breast cancer who underwent a radical breast operation. We examined the relationship between recurrence and the prognostic significance of clinico-pathological factors, particularly lymphatic (Iy) and vascular invasion (v).
  
  
  RESULTS
  The presence of lymphatic invasion and that of vascular invasion were significant in univariate analysis. The presence of vascular invasion was an independent prognostic factor, but lymphatic invasion lost its prognostic significance in multivariate analysis. Among the 91 patients in the ly-/v- group, 5 (5.5%) had disease recurrence, and among the 73 patients in the ly+/v- group, 5 (6.8%) had disease recurrence. On the other hand, among the 95 patients in the ly+/v+ group, 19 (20.0%) had a recurrence, and among the 3 patients in the ly-/v+ group, one had a recurrence. It is interesting to note that despite the presence of lymphatic invasion, the group without vascular invasion (ly+/v-) had a few patients with distant metastases, a result which is similar to that of the ly-/v- group.
  
  
  CONCLUSIONS
  The presence of vascular invasion, but not lymphatic invasion, could be an indicator of high biological aggressiveness and may be a valid prognostic factor for breast cancer.
authors.affiliation: FACS, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. taka.jifu@gmail.com.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Fujii
authors.forename: Reina
authors.initials: R
authors.lastname: Yajima
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hirakata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Tomomi
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Soichi
authors.initials: S
authors.lastname: Tsutsumi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ynagita
authors.forename: Misa
authors.initials: M
authors.lastname: Iijima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D001943:Breast Neoplasms / Q000098:blood supply / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000098:blood supply / Q000473:pathology*; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D009389:Neovascularization, Pathologic / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies
keywords: Vascular invasion; breast cancer; lymphatic invasion; prognosis