Prognostic significance of lymphatic invasion in lymph node-positive breast carcinoma: findings from a large case series with long-term follow-up using immunohistochemical endothelial marker

Interleukin-10: A double-edged sword in breast cancer

Breast cancer (BC) is a frequently diagnosed cancer among women worldwide. Currently, BC can be divided into different subgroups according to the presence of the following hormone receptors: estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2. Each of these subgroups has different treatment strategies. However, the presence of new metastatic lesions and patient deterioration suggest resistance to a given treatment. Various lines of evidence had shown that cytokines are one of the important mediators of tumor growth, invasion, metastasis, and treatment resistance. Interleukin-10 (IL-10) is an immunoregulatory cytokine, and acts as a poor prognostic marker in many cancers. The anti-inflammatory IL-10 blocks certain effects of inflammatory cytokines. It also antagonizes the co-stimulatory molecules on the antigen-presenting cells. Here, we review the current knowledge on the function and molecular mechanism of IL-10, and recent findings on how IL-10 contributes to the progression of BC.

D2-40 A Helpful Marker in Assessment of Lymphatic Vessel Invasion in Carcinoma of Breast

Background & Objective:

Breast cancer is the most common malignancy among Iranian women and worldwide. Lymphatic vessel invasion (LVI) was found to be an independent prognostic factor in many carcinomas, including invasive carcinoma of the breast. The aim of this study was to compare the hematoxylin and eosin (H&E) staining method and use of the immunohistochemical (IHC) marker ofD2-40, for evaluation of LVI in breast carcinoma specimens.

Methods:

The study was conducted on 50 patients undergone surgery between the years 2010 and 2015 in Rohani Hospital, Babol, Iran with invasive carcinoma of the breast with Census sampling method. LVI was assessed by two surgical pathologists, using H&E- stained sections and two IHC markers, i.e., D2-40 and CD31.

Results:

LVI was detected in 25 (50%) patients by H&E and in 14 (28%) patients by D2-40. Twelve out of 25 patients with positive LVI in H&E were confirmed by D2-40 and 2 out of 25 patients with negative lymphatic vessel in H&E. Only one case showed weak staining of CD31 proving LVI. These results showed a significant difference between the H&E staining and D2-40 IHC study for LVI detection (P=0.004).

Conclusion:

The D2-40 IHC marker is helpful in the diagnosis and confirmation of LVI in invasive carcinoma of the breast. CD31 is not suitable for the evaluation of lymphatic vessels.

Visualization of lymphatic vascular invasion in breast cancer by multiphoton microscopy

Lymphatic vascular invasion (LVI) is regarded as one of the independent factors which affect the prognosis of breast cancer. Once LVI is formed, it indicates the tumor has metastasized or has the possibility of metastasis. In this work, multiphoton microscopy (MPM), which relies on the two-photon excited fluorescence (TPEF) and second harmonic generation (SHG), was applied to identify the typical morphology of LVI and also visualize the histological features of LVI. Furthermore, the pixel density of collagen fibers was extracted as a quantitative parameter to differentiate LVI from the ductal carcinoma in situ (DCIS). By comparing with the corresponding H&E-stained images, it was confirmed that MPM can be used as an auxiliary tool for pathologists to diagnose LVI, and has a possibility for the application in clinical examination.

Lymphovascular invasion in breast cancer is associated with gene expression signatures of cell proliferation but not lymphangiogenesis or immune response

BACKGROUND

While the prognostic relevance of lymphovascular invasion (LVI) in breast cancer is well known, its molecular biology is poorly understood. We hypothesized that pathologically determined LVI reflects molecular features of tumors and can be discerned from their genomic and transcriptomic profiles.

METHODS

LVI status and Nottingham histological scores of primary breast tumors of The Cancer Genome Atlas (TCGA) project were assessed from pathology reports; other clinical and molecular data were obtained from TCGA data portals and publications. Two independent datasets (GSE5460 and GSE7849) were combined and used for validation.

RESULTS

LVI status was determinable for 639 and 196 cases of the TCGA and validation cohorts, among whom LVI incidence was 37.8% and 37.2%, respectively. LVI was associated with high tumor Ki67 expression, advanced pathologic stage, and high Nottingham scores. LVI-positive cases had worse overall and progression-free survival regardless of cancer subtype. Surprisingly, in both cohorts, LVI was not associated with lymphangiogenesis or lymphatic vessel density as estimated from tumor expression of lymphatic endothelium-associated genes. LVI-positive tumors had higher genome copy number aberrations, aneuploidy, and homologous recombination defects, but not single-nucleotide variations or intra-tumor genome heterogeneity. Tumor immune cell composition and cytolytic activity was not associated with LVI status. On the other hand, expression of cell proliferation-related genes was significantly increased in LVI-positive tumors.

CONCLUSION

Our study suggests that breast cancer with LVI is a highly proliferative cancer, and it does not correlate with gene expression markers for lymphangiogenesis or immune response.

US-guided Diffuse Optical Tomography: Clinicopathological Features Affect Total Hemoglobin Concentration in Breast Cancer

PURPOSE: To investigate breast cancers total hemoglobin concentration (THC) characteristics and its association with clinical pathologic findings. MATERIALS AND METHODS: The study was approved by the institutional review board and all patients provided written informed consent. 447 breast cancer patients, totally 455 lesions were included in our study. The size and THC of breast lesions were measured by conventional ultrasound (US) and US-guided Diffuse Optical Tomography (DOT) 1–2 days before surgery. Clinical and pathology information of patients was collected. RESULT: The average THC values of ER- or PR- lesions were significantly higher than the positive ones (P = .005 and P = .01,respectively); The average THC values of axillar LN+ or LVI+ were higher than the negative ones (P = .042 and P = .043, respectively). No significant THC difference was found in groups of infiltrating vs. non-infiltrating, HER2+ vs. HER2-, Ki67 high vs. Ki67 low, and different menstrual phases (P = .457, P = .917, P = .417, P = .213, respectively).The incidence ages and the lesion-nipple distances of T3 patients were lower than that of T1 and T2 (P < .001 and P < .001 respectively). The THC values and Ki67 indexes of T2 and T3 lesions were similar, but were higher than that of the T1 group (P < =0.001 and P = .006, respectively). CONCLUSION: Clinicopathological features of breast cancer, such as ER and PR status, axillary lymph node metastasis, lymphovascular invasion, correlate with THC values. Furthermore, the Ki67 indexes can be predicted using tumor size and THC, useful for pre-surgical evaluation of cancer biology and real-time, non-invasive monitoring of NAC efficacy.

IL-6 and IL-10 are associated with good prognosis in early stage invasive breast cancer patients

Macrophage-associated cytokines play an important role in cancer metastasis; however, the functions of interleukins (IL) 6 and 10 in breast cancer (BC) progression and metastasis are not clear. In this study the roles of IL-6/IL-10 in regulating vascular invasion and their prognostic significance in BC are investigated. MDA-MB-231 and MCF-7 migration (± IL-6 or IL-10) was assessed by scratch wound assay. Cancer cell adhesion to IL-6/IL-10 stimulated blood and lymphatic endothelial cells (EC) was investigated. Expression of IL-6 /IL-10 was assessed using immunohistochemistry in an annotated cohort of early stage BC (n = 1380) and associations with clinicopathological variables and clinical outcome evaluated. IL-6 did not alter BC cell migration however a dose-dependent inhibition in MDA-MB-231 migration with IL-10 treatment was observed (P = 0.03). BC cells were more adhesive to blood vs lymphatic EC, however, IL-6/IL-10 had no effect on adhesion patterns. High expression of IL-6/IL-10 was associated with clinicopathological criteria (e.g. hormone receptor status, all P < 0.05), improved disease-free survival (DFS; P < 0.05) and improved BC-specific survival (BCSS; only IL-6, P = 0.017). However, neither IL-6 nor IL-10 expression were independent prognostic factors from multivariate analysis. In BC subgroups, IL-6 and IL-10 were good prognosticators in terms of DFS in non-basal, non-triple-negative (non-TN), ER-positive, PgR-positive (only IL-10), and Her-2-negative (only IL-6) BC (all P < 0.05). IL-6 was associated with improved BCSS in non-basal, ER-positive and non-TN BC (all P < 0.05).

Prognostic significance of lymphatic vessel invasion diagnosed by D2-40 in Chinese invasive breast cancers

Lymphatic vessel invasion (LVI) is promising in determining prognosis and treatment strategies, but the application of LVI as a histopathological criterion in breast cancer patients especially those of different subgroups is controversial. This research aims to evaluate the prognostic value of LVI assessed by D2-40 not only in patients with early invasive breast cancer but also in lymph node-negative, lymph node-positive, luminal A-like, luminal B-like, HER2-enriched, and triple-negative subgroups.The study cohort included 255 patients with a median follow-up of 101 months. Immunohistochemical staining for D2-40 was performed to identify LVI.LVI was present in 64 (25.1%), 15 (12.1%), 49 (37.4%), 19 (20.9%), 23 (27.7%), 13 (31.7%), and 9 (22.5%), respectively, in the whole cohort, lymph node-negative, lymph node-positive, luminal A-like, luminal B-like, HER2-enriched, and triple-negative patients. LVI was associated with large tumor size (P = .04), high histological grade (P = .004), involved lymph node (P < .001), and high expression of Ki-67 (P = .003). No significant difference was found among patients with different subtypes and LVI status. The presence of LVI was significantly associated with adverse disease-free survival in the whole cohort (P < .001), lymph node-negative (P < .001), lymph node-positive (P < .001), luminal A-like (P < .001), and luminal B-like patients (P < .001) in both of the univariate and multivariate survival analysis.This study indicated that the presence of LVI stained by D2-40 provided independent prognostic information not only in the whole cohort but also in the subgroup of patients with lymph node-negative, lymph node-positive, luminal A-like, and luminal B-like diseases, which may make a case for routine clinical assessment of LVI using D2-40.

High lymphatic vessel density and presence of lymphovascular invasion both predict poor prognosis in breast cancer

Background

Lymphatic vessel density and lymphovascular invasion are commonly assessed to identify the clinicopathological outcomes in breast cancer. However, the prognostic values of them on patients’ survival are still uncertain.

Methods

Databases of PubMed, Embase, and Web of Science were searched from inception up to 30 June 2016. The hazard ratio with its 95% confidence interval was used to determine the prognostic effects of lymphatic vessel density and lymphovascular invasion on disease-free survival and overall survival in breast cancer.

Results

Nineteen studies, involving 4215 participants, were included in this study. With the combination of the results of lymphatic vessel density, the pooled hazard ratios and 95% confidence intervals were 2.02 (1.69–2.40) for disease-free survival and 2.88 (2.07–4.01) for overall survival, respectively. For lymphovascular invasion study, the pooled hazard ratios and 95% confidence intervals were 1.81 (1.57–2.08) for disease-free survival and 1.64 (1.43–1.87) for overall survival, respectively. In addition, 29.56% (827/2798) of participants presented with lymphovascular invasion in total.

Conclusions

Our study demonstrates that lymphatic vessel density and lymphovascular invasion can predict poor prognosis in breast cancer. Standardized assessments of lymphatic vessel density and lymphovascular invasion are needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3338-x) contains supplementary material, which is available to authorized users.