title: The relationship of lymphatic vessel density, lymphovascular invasion, and lymph node metastasis in breast cancer: a systematic review and meta-analysis.
abstract: Lymph node status is one of the key parameters used for determining the stage of breast cancer progression. The relationship of lymphatic vessel density (LVD), lymphovascular invasion (LVI), and lymph node metastasis (LNM) has not been clearly demonstrated yet. Databases of PubMed, Embase, and Web of Science were searched from inception up to 25 May 2016. Spearman correlation coefficient (r) and 95% confidence interval (CI) were used to determine the relationship within each group. Based on pre-established inclusion criteria, 28 studies involving 2920 breast cancer patients were included in this study. The r values of LVD-LVI, LVD-LNM, and LVI-LNM were 0.45 (95% CI: 0.31 to 0.57), 0.32 (95% CI: 0.23 to 0.40), and 0.24 (95% CI: 0.19 to 0.28), respectively. Compared with intratumoral LVD, peritumoral LVD showed more robust correlation with LVI (r = 0.53, 95% CI: 0.27 to 0.72) and LNM (r = 0.33, 95% CI: 0.18 to 0.46). The patients in LNM positive group presented with higher LVI detection rate of 45.85%, while in LNM negative group with detection rate of 23.85%. The results describe a triangle relationship between LVD, LVI, and LNM in breast cancer. Both LVD and LVI are indicated to be valuable predictors of LNM occurrence. Compared with intratumoral lymphatic vessels, peritumoral lymphatics might be the main disseminate route for breast tumor cells.
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Song
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Urology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Shanhong
authors.initials: S
authors.lastname: Yi
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Mingfu
authors.initials: M
authors.lastname: Gong
authors.affiliation: Department of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Caibao
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Yuanqing
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Department of Pathology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
authors.forename: Liguang
authors.initials: L
authors.lastname: Zou
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009389:Neovascularization, Pathologic; D017594:Publication Bias
keywords: breast cancer; lymph node metastasis; lymphatic microvessel density; lymphovascular invasion; meta-analysis