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Topic: "lymphovascular invasion is present" but negative nodes

Forum: IDC (Invasive Ductal Carcinoma) — Just diagnosed, in treatment, or finished treatment for IDC.

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Posted on: Mar 14, 2015 10:05AM

windingshores wrote:

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.



Dx 2/2015, DCIS/ILC/IDC, Right, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery Lymph node removal; Mastectomy: Right Surgery Mastectomy: Left; Prophylactic mastectomy: Left Hormonal Therapy
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Mar 14, 2015 02:20PM inks wrote:

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.

36 at DX, BRCA1+, multifocal/multicentric, 18 tumors, LVI Dx 8/21/2013, IDC, 5cm, Stage IIIA, Grade 3, 1/4 nodes, ER+/PR-, HER2- Chemotherapy 11/12/2013 AC + T (Taxol) Radiation Therapy 4/13/2014 Breast, Lymph nodes Hormonal Therapy 2/15/2015 Aromasin (exemestane)
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Mar 16, 2015 08:54PM CuriousCarm wrote:

"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.
Dx 1/15/2015, IDC, 1cm, Stage IA, Grade 3, 0/2 nodes, ER-/PR-, HER2+
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Mar 16, 2015 09:14PM Nancy2581 wrote:

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

2.8 cm tumor with LVI Dx 6/11/2014, IDC, Right, 2cm, Stage IIB, Grade 1, 1/3 nodes, ER+/PR+, HER2- (IHC) Surgery 6/24/2014 Lumpectomy: Right; Lymph node removal: Right, Sentinel Chemotherapy 7/22/2014 AC + T (Taxol) Hormonal Therapy 1/28/2015 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 1/29/2015 Whole-breast: Breast, Lymph nodes Hormonal Therapy 12/17/2017 Femara (letrozole)
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Mar 17, 2015 02:24PM mdg wrote:


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. 

Maria Visit my BC Blog at breastcancerwontdefineme.blogs... Dx 12/13/2010, IDC, 1cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 12/22/2010 Lumpectomy: Right Surgery 1/26/2011 Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 3/2/2011 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 5/18/2011 Surgery 6/21/2011 Reconstruction (left); Reconstruction (right) Surgery 12/9/2011 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Mar 17, 2015 05:47PM windingshores wrote:

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!

Dx 2/2015, DCIS/ILC/IDC, Right, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery Lymph node removal; Mastectomy: Right Surgery Mastectomy: Left; Prophylactic mastectomy: Left Hormonal Therapy
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Mar 17, 2015 08:52PM bevin wrote:


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.

Age 45, Oncotype 11, Primary Tumor 2.1 cm, smaller satellite tumor nearby Dx 8/8/2010, IDC, 2cm, Stage II, Grade 3, 0/5 nodes, ER+/PR+, HER2- Surgery 8/9/2010 Lumpectomy: Right; Lymph node removal: Right, Sentinel Radiation Therapy 10/9/2010 Breast
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Apr 12, 2015 09:39AM - edited Apr 12, 2015 09:40AM by ckim

This Post was deleted by ckim.
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Apr 12, 2015 09:41AM ckim wrote:

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??

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Apr 12, 2015 12:00PM Bounce wrote:

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.



Dx 8/5/2013, IDC, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 8/31/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Radiation Therapy 11/3/2013 Breast Hormonal Therapy 12/31/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Apr 12, 2015 01:23PM katcar0001 wrote:

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.

IDC left side, ER+/PR+/AR+. Oncotype 17, Ki-67 - 4%, MAPK1 and PIK3CA mutations. UMX 12/4/14, no chemo or rads. Tamoxifen 1/7/2015. Benign tumor removed from rt. side on 2/25/15. Started Anastrozole/Arimidex 7/4/17. Dx 11/22/2014, IDC, Left, 1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (IHC) Surgery 12/4/2014 Lymph node removal: Left, Sentinel; Mastectomy: Left Hormonal Therapy 1/7/2015 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 2/23/2015 Lumpectomy: Right Surgery 8/3/2015 Reconstruction (left): Tissue expander placement Surgery 11/19/2015 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Feb 7, 2017 10:32PM minatabo wrote:

Ckim

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

Dx DCIS/IDC, Both breasts, 4cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+
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May 3, 2017 03:25PM - edited May 3, 2017 03:29PM by Jenmia2002

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.

Diagnosed at 34 after finding tiny lump during my self breast exam. Dx 3/14/2017, IDC, Right, <1cm, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 4/25/2017 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy
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May 5, 2017 07:55AM KNardo88 wrote:

@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.

Kelly - Dx at age 27 - Luminal B - BRCA1+ ACx4 and OS & AI Dx 4/25/2016, IDC, Right, <1cm, Stage IA, Grade 3, 0/7 nodes, ER+/PR-, HER2- Surgery 5/20/2016 Lymph node removal: Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 6/23/2016 AC Hormonal Therapy 10/25/2016 Femara (letrozole) Surgery 11/1/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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May 16, 2017 11:06PM Tineandjoe wrote:

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

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Jun 9, 2017 07:18AM Lilneenz wrote:

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 :(

Surgery 2/22/2017 Mastectomy: Left Dx 3/10/2017, IDC, Left, 2cm, Stage IA, Grade 3, 0/4 nodes, ER-/PR-, HER2+ (FISH) Chemotherapy 4/9/2017 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Targeted Therapy 6/12/2017 Herceptin (trastuzumab) Chemotherapy
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Jun 9, 2017 07:19AM Lilneenz wrote:

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 :(

Surgery 2/22/2017 Mastectomy: Left Dx 3/10/2017, IDC, Left, 2cm, Stage IA, Grade 3, 0/4 nodes, ER-/PR-, HER2+ (FISH) Chemotherapy 4/9/2017 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Targeted Therapy 6/12/2017 Herceptin (trastuzumab) Chemotherapy
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Jun 9, 2017 02:32PM Nancy2581 wrote:

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

2.8 cm tumor with LVI Dx 6/11/2014, IDC, Right, 2cm, Stage IIB, Grade 1, 1/3 nodes, ER+/PR+, HER2- (IHC) Surgery 6/24/2014 Lumpectomy: Right; Lymph node removal: Right, Sentinel Chemotherapy 7/22/2014 AC + T (Taxol) Hormonal Therapy 1/28/2015 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 1/29/2015 Whole-breast: Breast, Lymph nodes Hormonal Therapy 12/17/2017 Femara (letrozole)
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Feb 7, 2019 11:28PM windingshores wrote:

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.




Dx 2/2015, DCIS/ILC/IDC, Right, 1cm, Stage IA, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery Lymph node removal; Mastectomy: Right Surgery Mastectomy: Left; Prophylactic mastectomy: Left Hormonal Therapy
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Feb 9, 2019 12:38PM Monl wrote:

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

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Feb 13, 2019 07:29PM - edited Feb 13, 2019 07:31PM by strawberrygurl

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.

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Feb 15, 2019 04:07AM Monl wrote:

i had LVI and that was after mastectomy reason for radiation because of recurrence change. Also taking Tamoxife

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Feb 15, 2019 04:18AM Monl wrote:

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

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Feb 15, 2019 05:12AM Monl wrote:

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

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Apr 4, 2019 12:44PM sthomas wrote:

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!!!

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Apr 4, 2019 01:20PM sthomas wrote:

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!!!

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Apr 4, 2019 01:38PM Monl wrote:

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🙏🏼🙋🏼♀️


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Sep 22, 2019 04:32PM Woman1 wrote:

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.



Chemotherapy 11/24/2018 AC + T (Taxol) Surgery 4/9/2019 Lumpectomy: Right; Lymph node removal: Sentinel Radiation Therapy 5/23/2019 Hormonal Therapy
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Oct 8, 2019 05:18PM Angelica74 wrote:

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.

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Oct 9, 2019 09:11PM monlee wrote:

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

Dx 6/18/2018, DCIS/IDC, Left, 2cm, Stage IIA, Grade 3, 0/2 nodes, ER+/PR+, HER2- (FISH) Surgery 7/19/2018 Mastectomy: Left, Right Chemotherapy 9/14/2018 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Nov 6, 2019 09:26PM Tmh0921 wrote:

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

First Dx at 27 years old in 1999, 2nd Dx 2018, 3rd Dx 2019... Current Oncotype: 26 Dx 12/7/1999, IDC, Left, 1cm, Stage IB, Grade 2, 0/15 nodes, ER+/PR+ Surgery 12/22/1999 Lumpectomy: Left; Lymph node removal: Left, Sentinel, Underarm/Axillary Radiation Therapy 1/31/2000 Whole-breast: Breast, Lymph nodes Hormonal Therapy 2/1/2000 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 8/24/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/5/2018 Lumpectomy: Left Dx 9/7/2018, DCIS, Left, <1cm, Stage 0, Grade 1 Dx 5/31/2019, IDC, Left, 3cm, Stage IIA, Grade 3, 0/2 nodes, ER+/PR+, HER2- (IHC) Surgery 8/5/2019 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Latissimus dorsi flap, Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 9/4/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/2/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Hormonal Therapy 3/24/2020 Femara (letrozole), Zoladex (goserelin) Surgery 7/16/2020 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant

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