Department of Surgery, Henry Ford Health System, Detroit, MI, USA.
Ann Surg Oncol. 2009 Dec;16(12):3396-405. doi: 10.1245/s10434-009-0659-2.
Lymphatic invasion is necessary for regional lymph node (RLN) metastasis in breast cancer (BC), while systemic metastasis requires blood vessel (BV) invasion. The site of BV invasion could be at the primary BC site or through lymphovascular anastomoses. The vague pathologic term "lymphovascular invasion" (LVI) encourages the belief that peri/intratumoral BV invasion may be common. We investigated the relative contribution of RLN metastasis to systemic metastasis by studying the relationship among LVI and RLN and/or systemic metastasis in a population-based cohort of breast cancer patients.
Fisher's exact test was done to assess global associations among LVI and RLN and/or systemic metastasis in a prospective database of breast cancer patients undergoing RLN biopsy. Logistic regression was used to determine multivariable contributions of LVI to metastasis when controlling for available demographic, radiologic, and pathologic variables.
Of 1668 patients evaluated 25.4% were RLN positive and 10.4% had LVI. RLN metastasis was predicted by tumor size (P < .0001), HER-2/neu overexpression (P = .0022) and the interaction between LVI positive and HER-2/neu positive tumors (< .0001). Patients with LVI/HER-2-neu positive were 3 times as likely to have positive RLNs compared with patients LVI/HER-2-neu negative. Systemic metastasis was significantly (P = .0013) associated with LVI/RLN positive, but not with LVI positive/RLN negative patients (P = .137).
LVI predicted RLN metastasis. LVI also significantly predicted systemic metastasis, but only when the RLN was also positive. Since RLN requires lymphatic invasion, these data support the hypothesis that primary breast cancers often invade lymphatics to gain access to the systemic circulation.
乳腺癌（BC）的区域淋巴结（RLN）转移需要淋巴管浸润，而全身转移则需要血管浸润。血管侵犯的部位可以是原发性乳腺癌部位，也可以是通过淋巴血管吻合。模糊的病理术语“血管淋巴管侵犯”（LVI）鼓励人们相信，peri/intratumoralBV 侵犯可能很常见。我们通过研究乳腺癌患者的前瞻性数据库中 LVI 与 RLN 和/或全身转移之间的关系，研究了 RLN 转移对全身转移的相对贡献。
在接受 RLN 活检的乳腺癌患者前瞻性数据库中，使用 Fisher 精确检验评估 LVI 与 RLN 和/或全身转移之间的全局关联。使用逻辑回归来确定在控制可用的人口统计学、影像学和病理学变量的情况下，LVI 对转移的多变量贡献。
在评估的 1668 例患者中，25.4%的 RLN 阳性，10.4%的患者有 LVI。RLN 转移由肿瘤大小（P <.0001）、HER-2/neu 过表达（P =.0022）和 LVI 阳性与 HER-2/neu 阳性肿瘤之间的相互作用（P <.0001）预测。与 LVI/HER-2-neu 阴性患者相比，LVI/HER-2-neu 阳性患者的 RLN 阳性率高 3 倍。系统转移与 LVI/RLN 阳性显著相关（P =.0013），但与 LVI 阳性/RLN 阴性患者无关（P =.137）。
LVI 预测 RLN 转移。LVI 也显著预测系统转移，但仅在 RLN 也阳性时才预测。由于 RLN 需要淋巴管浸润，这些数据支持这样一种假设，即原发性乳腺癌通常通过侵犯淋巴管进入全身循环。
