Pure Intralymphatic Invasion in the Absence of Stromal Invasion After Neoadjuvant Therapy
Bibliographic record
Abstract
Rarely is intralymphatic/lymph-vascular invasion (LVI) the only residual disease in the breast after neoadjuvant chemotherapy. Only 12 patients have been reported in 2 prior studies. Prognosis was poor, with only 2 patients remaining alive and disease-free. The purpose of this study was to gather more data on this pattern of residual disease. Cases in which LVI was the only residual disease in the breast were retrospectively identified. Eighteen cases were identified including 10 of 669 (1.5%) consecutive surgical cases between 2003 and 2015. The mean tumor size was 3.4 cm. Seven cancers were negative for estrogen receptor and HER2, 8 were HER2 positive, and 3 were estrogen receptor positive and HER2 negative. In 15 cases, lymph nodes were either suspicious by imaging or proven positive by biopsy. After neoadjuvant chemotherapy, 9 patients were node negative, 7 were node positive, and 2 had isolated tumor cells. Mean follow-up was 63.8 months (7 to 138 mo). Two deaths occurred in patients with positive nodes. One death occurred and 2 patients are alive with metastatic disease in the node-negative group. The remaining 13 patients are alive without disease. The outcome associated with residual LVI might not be as dismal as previously reported. Although the better outcome may be due to stage at presentation or the type of chemotherapy, it is difficult to compare the cohorts of the 3 studies. However, the death of 3 of 13 node-negative patients over the 3 studies supports not classifying residual LVI as a pathologic complete response.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".