Lymphangioinvasion detection using the monoclonal antibody D2–40 (Podoplanin)as a clinical predictor of axillary lymph node metastasis in breast cancer patients

Breast is a major global health issue and the most common cancer in women. Identifying vascular invasion is challenging due to the need to distinguish true invasion from artifacts. This study explored lymphatic embolism in invasive breast carcinoma using the monoclonal antibody D2-40 as a prognostic indicator. A total of 100 patients with invasive breast carcinoma from 2009 to 2011 were included in the study. Tissue microarray technique (TMA) was used on patient tissue, constructing three paraffin blocks from each participant's histological data. Immunohistochemistry with D2-40 and CD34 antibodies was performed to identify lymphatic and blood emboli, respectively, and results were compared with previous findings. A prior report using hematoxylin-eosin staining found fewer patients with lymphatic emboli (34) compared to our study (56) using D2-40. Lymphatic emboli correlated with axillary metastases, with an odds ratio (OR) of 3.50, a 95% confidence interval (CI) of 1.92-5.08, and a p-value of 0.001, whereas hematoxylin-eosin alone showed OR = 1.42, 95% CI = 0.40-3.47, and p-value = 0.23. TMA with D2-40 staining detected more lymphatic emboli than hematoxylin-eosin staining alone. Higher embolic expression rates are linked to increased tumor aggressiveness, worse prognosis and shorter overall survival.