LVI positive survivors
I’m having a hard time with the fact that my grade 3 tumor had LVI. My oncologist doesn’t think it’s a big deal since my nodes or negative, but I’ve read a lot of mixed info online about it and it keeps me up at night. Hoping that someone who has been through it can help me understand what this means as far as my recurrence risk.
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Hi @walsr014, From what I have read LVI increases the risk of recurrence by about 10%. For ER+ tumors this difference is reached after 10 years while for ER- tumors it’s reached after 5 years. The extent of LVI, whether focal, regular or extensive, also is a factor but I haven’t seen any statistical information on those differences.
ASCO does not consider LVI or close margins (< 1 mm) which I also had in treatment decisions. LVI is not related to the effectiveness of chemo which is determined by the Oncotype score for ER+ cancers. I finally came to the conclusion that the reason it is ignored is there is no treatment that will specifically compensate for it. My surgeon brushed both things off as inconsequential but my RO was more aggressive with my radiation plan because of them.
I’m now four years out from my diagnosis and have come to terms with the fact that there is no sure fire way of preventing recurrence. The most you can do is follow your treatment plan, live a healthy lifestyle and hope for the best. Initially I worried about it but over time it has gone to the back of my mind. Hopefully with time you’ll also be able to focus on living your life rather than worrying about something you can’t control. All the best.
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I had that, plus perineural invasion, and tried to talk my onc into giving me Verzinio or chemo even though I was stage 1 with a low oncotype. It can make you crazy trying to figure out how to control cancer. Thankfully your care team is only treating you based on proven guidelines and not playing cowboy with theoretical risk. Get a second opinion if you need some reassurance, but make sure you follow through with whatever therapy is rxed to you, get your scans, take care of diet, exercise and stress because those are all factors that reduce risk of recurrence.
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Hi Walsr014, Maybe consider taking a little melatonin to help you get more quality rest. Try to focus on the present while taking it slower.
The following are some examples of the many complexities. Best wishes for more peaceful and tranquil sleep.
"In addition fine needle aspiration or stereotactic techniques may result in the intravascular displacement of the benign epithelium [23,24,25,26], which may also be passively transferred to axillary lymph nodes following a biopsy or even breast massage [27,28]. However, in any case, these findings do not have a prognostic impact."
"During specimen processing, tissue retraction creates artifactual clefts around nests of invasive and in situ carcinoma that can mimic LVI. Such retraction or shrinkage artifacts can be difficult to differentiate from true lymphovascular lumens [14]"
"..Mohammed et al. elegantly showed that the vast majority (more than 97%) of tumor vascular emboli in lymph node-negative BC are indeed within lymphatic channels and often coexist with blood vessel invasion, further supporting the worthlessness of this discrimination [1]"
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Part of the "mixed information online" that concerns @walsr014 comes from the fact that there is a great deal of scientific information on the internet which was cutting edge research in its day but is now out of date. The above articles with older publication dates (1994, 1982, 2011, 1995, 1999) would fall into that category. It's also a good idea to find the entire original article if a synopsis comes up in a google search and to read the footnoted references if there is a question about a statement made. You can even go back to the original trial publication and look at the data set to evaluate the influence of trial number participants and their characteristics. All medical professionals involved follow the advice of their professional scientific bodies who develop public standards of care based on current research: ASCP, CAP, ABPath for pathologists; ASbrS for breast surgeons; ASCO for medical oncologists; and ASTRO for radiation oncologists. Most hospitals follow the treatment guidelines published by NCCN. Your treating physicians are usually the best source of information. However, some deal with multiple cancer types and other diseases and may not have the time or financial backing to keep up with the prodigious amount of scientific research done.
The above article (2023), as well as being a good overview, refutes the prior theory of LVI being caused by needle tumor seeding.
"For the authors, these findings corroborated the hypothesis that retraction clefts are not just a fixation artifact but the expression of an early stage of LVI [30,31]."
The above papers are recent (2021 and 2024); the first paper involves research in India while the second uses data from China. In the second paper the scale on the survival graphs makes things look much more dire than they are because the y-axis does not start from the origin.
Breast cancer LVI to mets is a long process that also involves cancer cell dormancy, circulating tumor DNA and the establsihment of cancer in another organ. Most of the time this process, even if it starts, never reaches the final stage. That 10% figure found by both of the above trials is just a statistical prediction and cannot tell what will happen to you. I feel better looking at the same statistic as a 90% chance the cancer will never metastasize. The usual risks of recurrence that are used to stage breast cancer as well as info like Oncotype risk predictions add to your personal situation. As @waves2stars advised you should do everything that is recommended to help prevent recurrence. If you have questions about your pathology report you can get a second opinion from a breast cancer specialist pathologist. I feel more confident knowing that such a pathologist wrote my report. @obsolete's recommendation of melatonin for insomnia caused by worry is a good one. If that doesn't help you should consult your PCP.
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Walsr, were your slides/path reviewed by a dedicated breast pathologist? If not, you may wish to pursue as others also suggested. Initially neglected to mention I'm a 12 yr survivor, grades 2-3, mixed invasive dx w/displacement or LVI (label it as you wish). Be careful of labels.
Living a healthy life, I never had ctDNA or any liquid biopsies run. Any of us can choose to believe what we wish. Please also try to nurture internal health with positive self-reflection.
The terminology used for malignant tumors and presentations of LVI can be perplexing to the uninitiated, myself included. Not one MD/PhD knows which paths lies ahead for any of us, so please rest easy.
Medicine is an imperfect industry. In every major industry, philosophically speaking, there exists a dichotomy. There are pitfalls. Epithelial displacement & entrapment of neoplastic cells is one such area. Special caution is required when examining areas around the needle core biopsy site and tract as architectural distortion & epithelial displacement can mimic invasion. Disrupted or displaced epithelium should not be relied upon for confirmation of diagnosis... but is it? Such observations tend to neglect valuable peculiar phenomenon seen in rarer BC subtypes, which are often dismissed because it challenges the norm in conventional BC subtypes. (LVI with Papillary Carcinoma is one such example.)
Although most of us are not medical professionals, some of us can still strive to think outside the box because we all need hope, inner peace and balance. Wishing your treatment plan will bring you many comforting years ahead.
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