Annals of Surgical Oncology

, Volume 16, Issue 12, pp 3396–3405 | Cite as

The Role of Lymph Node Metastasis in the Systemic Dissemination of Breast Cancer

  • S. David NathansonEmail author
  • David Kwon
  • Alissa Kapke
  • Sharon Hensley Alford
  • Dhananjay Chitale
Breast Oncology



Lymphatic invasion is necessary for regional lymph node (RLN) metastasis in breast cancer (BC), while systemic metastasis requires blood vessel (BV) invasion. The site of BV invasion could be at the primary BC site or through lymphovascular anastomoses. The vague pathologic term “lymphovascular invasion” (LVI) encourages the belief that peri/intratumoral BV invasion may be common. We investigated the relative contribution of RLN metastasis to systemic metastasis by studying the relationship among LVI and RLN and/or systemic metastasis in a population-based cohort of breast cancer patients.


Fisher's exact test was done to assess global associations among LVI and RLN and/or systemic metastasis in a prospective database of breast cancer patients undergoing RLN biopsy. Logistic regression was used to determine multivariable contributions of LVI to metastasis when controlling for available demographic, radiologic, and pathologic variables.


Of 1668 patients evaluated 25.4% were RLN positive and 10.4% had LVI. RLN metastasis was predicted by tumor size (P < .0001), HER-2/neu overexpression (P = .0022) and the interaction between LVI positive and HER-2/neu positive tumors (< .0001). Patients with LVI/HER-2-neu positive were 3 times as likely to have positive RLNs compared with patients LVI/HER-2-neu negative. Systemic metastasis was significantly (P = .0013) associated with LVI/ RLN positive, but not with LVI positive/RLN negative patients (P = .137).


LVI predicted RLN metastasis. LVI also significantly predicted systemic metastasis, but only when the RLN was also positive. Since RLN requires lymphatic invasion, these data support the hypothesis that primary breast cancers often invade lymphatics to gain access to the systemic circulation.


Breast Cancer Breast Cancer Sentinel Lymph Node Regional Lymph Node Axillary Lymph Node Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Supported by the Nathanson/Rands Chair in Breast Cancer Research. Patricia Baker did the abstracting for the database.


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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • S. David Nathanson
    • 1
    Email author
  • David Kwon
    • 1
  • Alissa Kapke
    • 2
  • Sharon Hensley Alford
    • 2
  • Dhananjay Chitale
    • 3
  1. 1.Department of SurgeryHenry Ford Health SystemDetroitUSA
  2. 2.Department of Biostatistics and Research EpidemiologyHenry Ford Health SystemDetroitUSA
  3. 3.Department of PathologyHenry Ford Health SystemDetroitUSA

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