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"lymphovascular invasion is present" but negative nodes

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windingshores
windingshores Member Posts: 160

My biopsy report indicated that "lymphovascular invasion is present" (DCIS, and IDC, 1.4 cm, estrogen+, Prog. +, HER2+ on FISH but equivocal on IHC).

I had a single mastectomy on 3/6 and pathology confirms that sentinal lymph nodes were negative. this is great news.

But I read somewhere that 20-30% of those with negative sentinal nodes during surgery have cancers that recur or spread.

What exactly does lymphovascular invasion mean? Is this another way of saying "invasive"? IDC is "invasive" but does IDC with lymphovascular invasion means something different (worse)? Just trying to clarify terms.

I see my oncologist on the 25th and have some idea of what might be in store. Right now I am still obsessing about when and how to get my other breast off and wishing the surgeon had not dissuaded me (based on other health issues and age) to wait on dealing with the other side.



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  • inks
    inks Member Posts: 57
    edited March 2015
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    LVI means that cancer had spread to blood vessels and lymph channels. Although you may have read that LVI correlates with recurrence or metastasis there are also studies that say this is not always true. When I asked my oncologist about it he shrugged his shoulders and said that it does not necessarily mean poorer prognosis. There are so many things that affect metastasis and we don't know the half of it yet. But my LVI did get me radiation to everything but the intramammary nodes. Don't get yourself worked up about this, this is something you can't change, concentrate on things you can change - like adhering to your doctors treatment plan and continuing a healthy lifestyle. I am with your doctor, keep the other breast if you can, it's not fun to not have any feeling anywhere on my chest.

  • CuriousCarm
    CuriousCarm Member Posts: 18
    edited March 2015
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    "LVI is present" means that they see tumour cells within blood or Lymphaetic cells in the sample they are testing.
    This does not necessarily mean that the tumour cells are traveling your body. It just increases the chances that there may be. There are three levels of LVI, which are:
    Focal - very small area of sample showing LVI. No effect on recurrence/ prognosis.
    Intermediate/Moderate - an area of the sample is showing LVI. No effect on recurrence/prognosis.
    Extensive - LVI covers a large portion or the entire sample. Does effect recurrence as if it was one positive lymph node.

    LVI is not used as an independent prognostic factor. It's just used to determine if chemo is required because it increases the chances of tumour cells traveling the body. However, to have negative lymph nodes is absolutely great news even with LVI. Most of the time, with LVI, the tumour cells go to the lymph nodes first before it goes anywhere else in the body. Then from the lymph nodes it can lead to metastasis. Sometimes you will see people with positive lymph nodes and no LVI. Most say that this is a false negative.
    So, there is a chance that tumour cells could be traveling the body if you see LVI present. Chemo should clean that up if the cells are indeed elsewhere in the body.
  • nancy2581
    nancy2581 Member Posts: 408
    edited March 2015
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    I had LVI but all it said on my path report was that LVI was present. I asked my MO about it and she said it does put me at a higher risk but chemo should take care of it. Hope so

  • mdg
    mdg Member Posts: 1,468
    edited March 2015
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    I had LVI and clear nodes.  Freaked me out!  I did only read mostly negative things about LVI and it was very concerning to me.  I was in a gray area for chemo and the LVI pushed me over the edge to do the chemo.  I did TCx4 and used cold caps to keep my hair.  It was not fun, but I was done in 9 weeks and moved on with my hair. 

  • windingshores
    windingshores Member Posts: 160
    edited March 2015
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    Thanks all. I am having chemo anyway due to HER2+ and it will help with the LVI. I have these little bouts of anxiety when I read too much and then go back to watching movies!

  • bevin
    bevin Member Posts: 519
    edited March 2015
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    Hi, I also had been told that LVI being present was based on the time of surgery ;  So, at the time they did your surgery the cells were either there or not.  This as I understood, doesn't mean they may have been there and moved along; therefore no LVI would be present during surgery . Does anyone else have that understanding.?  I may not have clearly written /explained what I was told, but its a moment in time test. so just because it is or is not there at the moment they perform surgery, doesn't preclude it from being there before.

     

    Let me know your thoughts.

  • ckim
    ckim Member Posts: 2
    edited April 2015
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    Hi all, I just found out that I had LVI from my rad onc. Due to the LVI and grade 3 tumour and my age, I'm 31 y/o, he's recommending radiation. I had a mastectomy with immediate recon(tissue expanders in place) and undergoing chemo right now. My margins are clear and my lymph nodes were negative. I'm thinking do I really need the radiation?? 

  • ckim
    ckim Member Posts: 2
    edited April 2015
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    Hi all, I just found out that I had LVI from my rad onc. Due to the LVI and grade 3 tumour and my age, I'm 31 y/o, he's recommending radiation to reduce recurrence. I had a mastectomy with immediate recon(tissue expanders in place) and undergoing chemo right now. My margins are clear and my lymph nodes were negative. I'm thinking do I really need the radiation if my margins are clear and nodes are negative??

  • bounce
    bounce Member Posts: 215
    edited April 2015
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    Very interesting thread.

    My BS said this would have no effect on my treatment plan (I was not offered chemo).

    I read this on wikipedia under

    Lymphovascular invasion - prognostic significance

    - not the most reliable source but they do have a reference to a study.

    Breast cancer

    In breast cancer, LVI is not an independent risk factor for a poorer prognosis.[5]

    In other types of cancer it is a risk factor for poorer prognosis.

    I feel a little calmer.



  • katcar0001
    katcar0001 Member Posts: 321
    edited April 2015
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    Could a core needle biopsy also cause "focal" LVI? I have been wondering that for weeks.

    ckim - One RO recommended rads to me for LVI and Grade 2. However, he did not take into account the extend of LVI or that I am on Tamoxifen. In your situation, I would be more concerned about your age and being Grade 3. I would get several opinions.

  • minatabo
    minatabo Member Posts: 6
    edited February 2017
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    Ckim

    Did you end up going for second opinion? Did you end up doing radiation?

  • Jenmia2002
    Jenmia2002 Member Posts: 3
    edited May 2017
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    I know this is old topic but I had my original biopsy March 10th 2017 with LVI not present. Had my lumpectomy last week and found out today LVI Present, Focal. My Mammoprint is Low Risk so no chemo just radiation. MO said this will be something that my RO will address in my treatment with Rads. My tumor was only 9mm with clean margins and 3 nodes were all negative. The LVI is a little worrisome but neither my BS or MO are worried.


    katcar0001 I too wanted to know if a core needle biopsy could cause it to change from Negative LVI to Positive LVI. It would make sense to me that it could cause it.

  • KNardo88
    KNardo88 Member Posts: 3
    edited May 2017
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    @jenmia2002, My original biopsy said LVI absent, then I had a 2nd opinion who examined the SAME specimen and indicated that LVI was present. Then, I had my double mastectomy and final pathology was LVI absent. I was very confused, but told that it could have been that the 2nd opinion pathologist thought they saw it present (small enough amount to have been mistaken), and to go off of what the final pathological findings on the whole tumor after the surgery states. I still worry, though.

  • Tineandjoe
    Tineandjoe Member Posts: 3
    edited May 2017
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    I had a double mastectomy on April 19th for invasive lobular Carcinoma. Pathology came back as stage 2 and another small 2mm mass. I also had a micro mess (1.5 mm) in the sentinel lymph node.it spread to the lymph node yet was born considered positive or negative so it was sent for oncotype testing.

    Today I Got my oncotype score...it's low, a 14. That's great. Under 18 is no chemo. BUT...there's always a but, 20 plus doctors are all involved in my case now. I'm in a grey area. The cancer that spread to my lymph node was an extensive lympho vascular invasion. Anyone experience this?? I sooo want to avoid chemo! I have three little ones

  • neenz73
    neenz73 Member Posts: 11
    edited June 2017
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    hi

    I'm really worried about lymphovascular invasion - I'm halfway through treatment for her2 positive idc, neg nodes but grade 3/ but this is worrying me every minute - my onc doesn't seem worried but I Am :(

  • neenz73
    neenz73 Member Posts: 11
    edited June 2017
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    hi

    I'm really worried about lymphovascular invasion - I'm halfway through treatment for her2 positive idc, neg nodes but grade 3 / but this is worrying me every minute - my onc doesn't seem worried but I Am :(

  • nancy2581
    nancy2581 Member Posts: 408
    edited June 2017
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    Hi Lilneenz - I was really worried about having LVI too. My MO didn't seem worried either. She said yes it does pose an extra risk, but you're doing chemo so it will take care of it. Hope that helps a little

    Nancy

  • windingshores
    windingshores Member Posts: 160
    edited February 2019
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    Coming back to this four years later. Turns out I was HER2-, grade 2 or 3, clean nodes, ki67% 19,  95% ER and 80% PR, and low Oncotype score, surprisingly. I had a positive biopsy pathology report for HER2, one equivocal and one negative and had a tie-breaker 4th doc who retested with 60 cells instead of 20 and got a negative.

    My LVI was lymphatic and focal.

    I had two mastectomies (the second breast was full of cysts, had some precancerous cells, and since my cancer was partly lobular it was a good idea to do the second one). I was much more comfortable with both breasts off.

    Anyway despite the grade 3 and LVI, with the low Oncotype, I did not do chemo. I did not do radiation though one out of five RO's would have done it in my situation.

    I was 63 then, and have some other health issues, and was grateful for the low Oncotype that spared me chemo.

    Now finishing my 4th year of Femara and doing okay so in case anyone reads this, so far the LVI has not endangered me.

    I don't think much about cancer except before appointments.




  • Monl
    Monl Member Posts: 9
    edited February 2019
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    Thanks for this info.

    Was wondering if stage plays a role wirh LVI? I have had a mastectomy and my tumor is ER/PR+ HER- grade 1. No chemo but there was decided i needed to have radiation because of the LVI. I

  • strawberrygurl
    strawberrygurl Member Posts: 1
    edited February 2019
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    I recently had a mastectomy, also with ER/PR+, HER2- and Grade 2. My onc recommends hormone therapy (no chemo) but I've seen so many others on here who have had chemo and/or radiation for the LVI, I'm concerned that hormone therapy alone is not enough. My sentinel node biopsy was negative. It seems that according to others LVI is reason alone to opt for chemo. I have a second opinion scheduled 10 days from now. Can anyone possibly shed some light as to what their doctor said to indicate why or why not do chemotherapy? My Path Prognostic Stage is 1A.

  • Monl
    Monl Member Posts: 9
    edited February 2019
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    i had LVI and that was after mastectomy reason for radiation because of recurrence change. Also taking Tamoxife

  • Monl
    Monl Member Posts: 9
    edited February 2019
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    there is a online calculator for recurrence risk after LVI. I am not allowed to post here so send me a message if possible. It works with points and other feature

  • Monl
    Monl Member Posts: 9
    edited February 2019
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    Sorry for the spelling mistakes in my previous messages but was quickly replying.

    Chemo suppose to have less/minimum effect on ER/PR positive tumors with low grade and low stage. I was also very concerned but was told I would not benefit from chemo. The radiation was because of the LVI. Since it was on my left side( heart) more risk and also my lung could be damaged. Need to go for diepflap because prothese after radiation means trouble. But even so I asked two different hospitals in the netherlands and both said: radiation is a must. So i did it of course

  • sthomas
    sthomas Member Posts: 2
    edited April 2019
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    I an new to this site and happy to find a group to share concerns and questions. I was diagnosed with Stage 1B BC ER/PR+ and HER2- in January. I had a unilateral mastectomy and now have the tissue expander. I had isolated cells in my sentinel node and LVI. My onco score was a 19. They have recommended no chemo and are now saying no radiation. My onco says that isolated cells are considered node negative. The LVI is what really scares me. I certainly don't wish chemo or radiation on myself, but want to make sure I do everything possible to decrease my chance of re-occurrence. They are recommending the monthly shot to shut down my ovaries so I can take an AI vs. Tamoxifen. The other option would be ovary removal. I am 51 and just had blood work done to determine how close I might be to menopause. I am certainly in the midst of it. Anyone have any experience with LVI and radiation? Also, I know the radiation will effect my reconstruction. Anyone used implant reconstruction after radiation. Thanks!!!

  • sthomas
    sthomas Member Posts: 2
    edited April 2019
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    strawberryg, I am curious what they said in your second opinion about radiation and chemo with your LVI. Your situation sounds much like mine. Thanks!!!

  • Monl
    Monl Member Posts: 9
    edited April 2019
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    I undersrand your worries. With me after the LVI they did want to go with rads because of recurrence. I read terrible things about LVI if you google it but they were quite relaxed about it and the rads would bring my changes down of recurrence a lot. . I am happy I did it. I want to do everything. I got my radiotherapy in a different hospital and the oncologist radiotherapist said: a good choice to go for radiation with LVI. It is in the dutch oncology guidelines. Not to act interesting but dutch breastcancer research is leading worldwide.

    I suppose to take an implant but after rads it can sometimes cause problems. My surgeon said he had find one implant with good results but I decided to go for a deep flap at july 1st.

    Decisions decisions decisions... and big ones. Good luck on making yours sister🙏🏼🙋🏼♀️


  • Woman1
    Woman1 Member Posts: 1
    edited September 2019
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    Thank you for posting this information!

    This sounds accurate. I have been wondering like hell what lymph vascular invasion means. Would it be possible to cite the source?

    I finished my radiation in July 2019, a little less than 3 mo ago, and had my port removed a few days ago. Whenever I visit the hospital for surgery related appointment, I am caught by the idea of recurrence and met. Perhaps because it was my breast surgeon who gave me the diagnosis. The radiation oncologist told me my chance of recurrence is “low," but not in a number. (understandably.)

    Before starting chemo last November, because of PET result, bone scan was ordered “just to make sure" that terrified me. The report says “bone metastasis is unlikely," but I can never forget the terror when I saw a white spot on the screen.

    Whenever I feel tired, pain in my back, shoulder, and arm, and even constipation as well as hearing someone's story who died who had been initially diagnosed IIB, my mind starts wondering.



  • angelica74
    angelica74 Member Posts: 6
    edited October 2019
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    I was diagnosed with stage 1 IDC, node negative, ER/PR+ her2- , grade 3 with lvi. I did double mastectomy and chemo, just started my Anatrozole 2 weeks ago. My onco says no rads needed but I keep feeling like I should with the grade 3 and lvi also I'm only 45. I'll ask him again at appt oct 31.

  • monlee
    monlee Member Posts: 5
    edited October 2019
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    Angelica74 - you are very similar to me. Stage 2, node negative, lvi and grade 3. Had bmx and chemo no rads. Dr said now that everything is gone there is nothing to radiate. I am also on anastroloze. I dont know if we ever stop wondering

  • tmh0921
    tmh0921 Member Posts: 519
    edited November 2019
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    I had LVI present, but pathologist further clarified it as Foci of LVI. MO said they are concerned if it’s extensive LVI. I had a BMX, and chemo due to an oncotype score of 26 at age 47. I will also start an AI in a few weeks. My treatment should offset the risk of the LVI