@auntieoakley I don't see much that is new in these studies, despite the fact that they are much more recent than my own cancer and research back then. The studies do describe LVI as in the "peritumoral area" which means on the edge of the tumor, still in the breast.

I have read that it can be seen as equivalent in risk to one positive node but the first study you cited said 1-2. That study did not apparently differentiate between focal and extensive and it is unclear there whether focal is lower risk.

They also did not differentiate between lymph and blood vessel invasion. If Lymph, the cells had not reached the nodes or they would have shown up in the sentinel node, I assume.

In my view all of this means the studies are flawed and we need better ones.

All of this is scary for me at 10 years. Doctors in 2014 didn't even want to discuss LVI, it wasn't considered in the Oncotype (mine was weirdly low with LVI, high ki67% and grade 3) or any of the online risk calculators. I personally feel that those of us with LVI should qualify for the Signatera blood test that those with 1 lymph node qualify for, to test for spread.

I like to think it was all removed with mastectomy but cells could have gotten through and the important factor is the ability to travel and implant of these cells.

How the heck are we supposed to catch metastasis? My surgeon says focal persistent pain which many of us older folk have. With 7 spinal fractures, lumbar and cervical stenosis and osteoarthritis I am not going to pick up on a particular pain.