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Lymphatic and angiogenic characteristics in breast cancer: morphometric analysis and prognostic implications

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Abstract

Controversy exists regarding the topography of lymph vessels in breast cancer, their usefulness as prognostic factors, relationship with angiogenesis and whether active lymphangiogenesis occurs within the tumour. A series of 177 well-characterized breast cancers, with long term follow up, were stained with D2-40, CD31 and CD34. Distribution of lymphatics and lymph vessel density (LVD) were assessed in three areas, intratumoural, peripheral and peritumoural and correlated with clinicopathological criteria and patient prognosis. Microvessel density (MVD) was assessed and correlated with LVD. Double immunohistochemical staining with D2-40 and MIB-1 was carried out to assess the proliferative status of lymphatics and of the tumour emboli within. Peritumoural lymphatics were detected in all tumours whereas peripheral and intratumoural lymphatics were detected in 86 and 41% of specimens, respectively. Tumours with higher total LVD were significantly associated with the presence of lymph node (LN) metastasis and shorter overall survival (OS). In multivariate analysis, tumour grade, LN status and the presence of lymphovascular invasion, but not LVD, were independent poor prognostic factors. No association was found between LVD and MVD. Proliferating lymphatics were detected in 29% of specimens and were significantly associated with dense inflammatory infiltrate. In conclusion, lymphatics are located primarily in the peritumoural and peripheral areas in breast cancer and seem to play an important role in disease progression by being routes for tumour dissemination. The lack of correlation between lymphangiogenic and angiogenic characteristics suggests two distinct processes and the presence of active lymphangiogenesis, albeit in a small portion of specimens, may have important therapeutic implications.

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Acknowledgments

Rabab A. A. Mohammed is very grateful to the Egyptian government for funding her during this work. The authors are also grateful to Mrs. Kelly Huber and Miss Aula Ammar (University of Nottingham, University Hospitals, Department of Clinical Oncology) for their kind technical support and valuable advice.

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Authors and Affiliations

  1. Department of Clinical Oncology, University of Nottingham, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

    Rabab A. A. Mohammed & Stewart G. Martin

  2. Department of Histopathology, University of Nottingham, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

    Rabab A. A. Mohammed, Ian O. Ellis, Somaia Elsheikh & Emma C. Paish

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  1. Rabab A. A. Mohammed
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  2. Ian O. Ellis
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  3. Somaia Elsheikh
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  4. Emma C. Paish
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  5. Stewart G. Martin
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Correspondence to Stewart G. Martin.

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Mohammed, R.A.A., Ellis, I.O., Elsheikh, S. et al. Lymphatic and angiogenic characteristics in breast cancer: morphometric analysis and prognostic implications. Breast Cancer Res Treat 113, 261–273 (2009). https://doi.org/10.1007/s10549-008-9936-1

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  • DOI: https://doi.org/10.1007/s10549-008-9936-1

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