Kuhn Elisabetta, Gambini Donatella, Despini Luca, Asnaghi Dario, Runza Letterio, Ferrero Stefano
Department of Biomedical Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy.
Pathology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Biomedicines. 2023 Mar 21;11(3):968. doi: 10.3390/biomedicines11030968.
Traditionally, lymphovascular invasion (LVI) has represented one of the foremost pathological features of malignancy and has been associated with a worse prognosis in different cancers, including breast carcinoma. According to the most updated reporting protocols, the assessment of LVI is required in the pathology report of breast cancer surgical specimens. Importantly, strict histological criteria should be followed for LVI assessment, which nevertheless is encumbered by inconsistency in interpretation among pathologists, leading to significant interobserver variability and scarce reproducibility. Current guidelines for breast cancer indicate biological factors as the main determinants of oncological and radiation therapy, together with TNM staging and age. In clinical practice, the widespread use of genomic assays as a decision-making tool for hormone receptor-positive, HER2-negative breast cancer and the subsequent availability of a reliable prognostic predictor have likely scaled back interest in LVI's predictive value. However, in selected cases, the presence of LVI impacts adjuvant therapy. This review summarizes current knowledge on LVI in breast cancer with regard to definition, histopathological assessment, its biological understanding, clinicopathological association, and therapeutic implications.
传统上，淋巴管浸润（LVI）一直是恶性肿瘤最重要的病理特征之一，并且与包括乳腺癌在内的不同癌症的预后较差相关。根据最新的报告方案，乳腺癌手术标本的病理报告中需要评估LVI。重要的是，LVI评估应遵循严格的组织学标准，然而，病理学家之间的解释不一致给LVI评估带来了阻碍，导致观察者间差异显著且重现性差。目前的乳腺癌指南表明，生物学因素与TNM分期和年龄一样，是肿瘤学和放射治疗的主要决定因素。在临床实践中，基因组检测作为激素受体阳性、HER2阴性乳腺癌的决策工具的广泛应用以及随后可靠预后预测指标的出现，可能已经降低了人们对LVI预测价值的兴趣。然而，在某些特定情况下，LVI的存在会影响辅助治疗。本综述总结了目前关于乳腺癌LVI在定义、组织病理学评估、生物学理解、临床病理关联及治疗意义方面的知识。
