The prediction of lymph node metastasis in ductal carcinoma in situ with microinvasion by assessing lymphangiogenesis

Background and Objectives: Lymph node (LN) metastasis of ductal carcinoma in situ with microinvasion (DCISM) is variable (0-14%). To ascertain the role of lymphangiogenesis in LN metastasis in DCISM, we compared the lymphatic vessel density with the presence of LN metastasis in a group of patients that underwent axillary dissection with breast surgery due to DCISM. Methods: We identified 46 patients with a diagnosis of DCISM who underwent breast surgery with axillary dissection to evaluate LN status from June 1996 to March 2008. Microvessel density (MVD) and lymphatic vessel density (LVD) was measured by immunohistochemical staining with two markers, CD34 and D2-40. Results: LVD of the patients with LN metastasis was significantly higher than that of the patients without LN metastasis (P = 0.04). Correlation in the total score of progesterone receptor and LN metastasis was also noted (P = 0.017). There was no statistically significant relation between LVD and clinicopathologic parameters such as size and type of underlying DCIS, nuclear grade, presence of lymphovascular invasion, hormone receptor, and HER-2 status. Conclusions: Lymphangiogenesis may be significantly associated with LN metastasis in DCISM. This is the first attempt to predict axillary LN metastasis in DCISM by quantifying the LVD.