D2-40 in breast cancer: should we detect more vascular emboli?

Abstract

Peritumoral emboli assessed on hematoxylin-eosin-stained slides are taken into account for treatment of patients with operable breast cancer. We assessed whether immunostaining with D2-40 improves the prognostic significance of emboli in a group of tumors with a large immunohistochemical sampling and a long-term follow-up. Topography, number, and extension of hematoxylin-eosin and D2-40 emboli were compared in 94 node-negative breast cancers (median number of immunostained slides per tumor: 3). Metastasis-free survival of patients with or without hematoxylin-eosin and/or D2-40 emboli were evaluated (median follow-up of 178 months). Hematoxylin-eosin emboli were detected in 14 (15%) tumors and were located at distance from the tumor. D2-40 emboli were detected in 39 (41%) tumors and was often multiple (n=30), extensive (n=23), located within (n=13), close to (n=10) or at distance from the tumor (n=16). The 12 distant hematoxylin-eosin and D2-40 emboli were located in the same vessels (seven missed at the first hematoxylin-eosin examination and secondarily diagnosed by D2-40 staining). A difference in metastasis-free survival was found only between patients with no D2-40 emboli and those with distant D2-40 emboli (P=0.02). D2-40 emboli located within or close to the tumor had no prognostic value. Comparing the metastasis-free survival of patients with or without hematoxylin-eosin emboli, the prognostically unfavorable significance of hematoxylin-eosin emboli was improved when taking into account the seven patients with missed emboli at the first examination and secondarily diagnosed by D2-40 staining (P=0.006 vs 0.003). To conclude, D2-40 increases the diagnostic sensitivity of emboli in breast carcinoma and the high incidence of D2-40 emboli might be related to the number of immunostained slides per case. Nevertheless, only distant D2-40+ emboli had a prognostic impact. In practice, D2-40 might be useful to detect missed hematoxylin-eosin emboli especially in cases without any other prognostically unfavorable criterion.

• Authors: Isabelle de Mascarel, Gaëtan MacGrogan, Marc Debled, Ghislaine Sierankowski, Véronique Brouste, Simone Mathoulin-Pélissier, Louis Mauriac
• Journal: Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc (Mod Pathol) Vol. 22 Issue 2 Pg. 216-22 (Feb 2009) ISSN: 1530-0285 [Electronic] United States
• PMID: 18820667 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Antigens, Tumor-Associated, Carbohydrate
• Coloring Agents
• monoclonal antibody D2-40
• Eosine Yellowish-(YS)
• Hematoxylin

Topics

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Antigens, Tumor-Associated, Carbohydrate (analysis)
• Blood Vessels (immunology, pathology)
• Breast Neoplasms (diagnosis, immunology, pathology, therapy)
• Carcinoma (diagnosis, immunology, pathology, therapy)
• Coloring Agents
• Embolism (diagnosis, immunology, pathology)
• Eosine Yellowish-(YS)
• False Negative Reactions
• Female
• Hematoxylin
• Humans
• Immunohistochemistry (methods)
• Kaplan-Meier Estimate
• Lymphatic Metastasis
• Lymphatic Vessels (immunology, pathology)
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Metastasis
• Neoplastic Cells, Circulating (immunology, pathology)
• Predictive Value of Tests
• Reproducibility of Results
• Staining and Labeling (methods)
• Time Factors
• Treatment Outcome