J Breast Cancer.  2012 Dec;15(4):478-480. 10.4048/jbc.2012.15.4.478.

Differentiating Lymphovascular Invasion from Retraction Artifact on Histological Specimen of Breast Carcinoma and Their Implications on Prognosis

• Zaorsky NG
• Patil N
• Freedman G
• Tuluc M

• KMID: 2286448
• DOI: http://doi.org/10.4048/jbc.2012.15.4.478

Abstract

On a pathological specimen of breast cancer cells, retraction artifact during histological processing mimics true lymphovascular invasion (LVI). The accurate determination of the presence or absence of LVI is a factor in determining risk of having a positive sentinel node, or having additional positive axillary nodes after a positive sentinel node biopsy in women with early-stage breast cancer. The determination of nodal risk influences the decision of the treating physicians as to whether a sentinel node biopsy or completion axillary dissection is necessary. On slide preparation, ideal factors favoring true LVI include: a definite endothelial lining, with endothelial nuclei that seem to protrude into the lymphatic space; invasion in one lymphatic vessel (LV) lumen with nearby cancer glands that have minimal or no retraction; a tumor embolus in a LV clear lumen with outside nearby tumor bulk; a tumor embolus that is different in shape than its surrounding clear LV space; and a positive stain for fibrin, CD31, or CD34 on tumor embolus periphery.

Keyword

Breast neoplasms; Diagnosis; Pathology

MeSH Terms

Artifacts
Biopsy
Breast
Breast Neoplasms
Embolism
Female
Fibrin
Glycosaminoglycans
Humans
Lymphatic Vessels
Nitriles
Prognosis
Pyrethrins
Fibrin
Glycosaminoglycans
Nitriles
Pyrethrins

Figure

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  Figure 1 In breast stroma, cancer cells form in clusters near lymphatic vessels and as glands.

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  Figure 2 True lymphovascular invasion (LVI) as (A) an illustration, and (B) on histological specimen with hematoxylin and eosin (H&E stain,×20), CD31, and CD34 staining (both at ×40 magnification, with detail emphasizing the lymphatic space involved).

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  Figure 3 Retraction artifact mimicking lymphovascular invasion as (A) an illustration, and (B) on histological specimen of three separate samples (H&E stain,×20).

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