Kovács Anikó, Rundgren-Sellei Åsa, Rask Gunilla, Bauer Annette, Bodén Anna, van Brakel Johannes, Colón-Cervantes Eugenia, Ehinger Anna, Hartman Johan, Acs Balazs
Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden.
Breast. 2025 Jun 9;82:104519. doi: 10.1016/j.breast.2025.104519.
The assessment of residual lymphovascular invasion (LVI) in breast cancer patients undergoing neoadjuvant therapy may be a critical factor influencing prognosis and treatment decisions. However, there is a notable discrepancy between the RCB, UICC/AJCC, and ICCR guidelines regarding how LVI should be evaluated and reported in this context. ICCR recommends including LVI in the invasive tumor size for neoadjuvant treated patients with only residual LVI affecting the Residual Cancer Burden (RCB) score. AJCC suggests that LVI should not be evaluated as invasive cancer. However, they do not recommend that such cases are considered as complete response. The RCB method does not address the LVI question at all. This editorial aims to explore the implications of these differing recommendations, highlighting the challenges in clinical practice. Even though there is limited evidence in the literature on this subject, leaving this discrepancy unaddressed leads to high variability in the staging of neoadjuvant-treated breast cancer patients among pathologists. This, in turn, may cause confusion in the clinical decision-making for these patients. The recommendation of the Swedish Breast Pathology Expert Group (KVAST breast) based on current evidence, is to report LVI as a separate prognostic biomarker in neoadjuvant setting and reporting it separately from the RCB treatment response criteria. For breast cancer patients with only LVI as residual disease in the breast without any lymph node metastasis after NACT, the Swedish Breast Pathology Expert Group recommends the following staging: RCB-0, pPR, ypT0, ypN0, L1.
对接受新辅助治疗的乳腺癌患者的残余淋巴管浸润（LVI）进行评估，可能是影响预后和治疗决策的关键因素。然而，在这种情况下，关于如何评估和报告LVI，皇家病理学会（RCB）、国际抗癌联盟（UICC）/美国癌症联合委员会（AJCC）和国际乳腺癌研究协作组（ICCR）的指南之间存在显著差异。ICCR建议，对于仅残余LVI影响残余癌负担（RCB）评分的新辅助治疗患者，将LVI纳入浸润性肿瘤大小。AJCC认为不应将LVI评估为浸润性癌。然而，他们不建议将此类病例视为完全缓解。RCB方法根本没有涉及LVI问题。这篇社论旨在探讨这些不同建议的影响，突出临床实践中的挑战。尽管关于这一主题的文献证据有限，但不解决这一差异会导致病理学家对新辅助治疗的乳腺癌患者进行分期时差异很大。这反过来可能会导致这些患者临床决策的混乱。基于现有证据，瑞典乳腺病理专家组（KVAST breast）建议，在新辅助治疗情况下，将LVI作为一个单独的预后生物标志物报告，并与RCB治疗反应标准分开报告。对于新辅助化疗（NACT）后乳房仅残留LVI作为疾病且无任何淋巴结转移的乳腺癌患者，瑞典乳腺病理专家组建议如下分期：RCB-0，pPR，ypT0，ypN0，L1。
