I had "focal" lymphovascular invasion and one report specified lymph vessels. Grade 3, highish ki67%, but no nodes and low Oncotype. (My first pathology also had me as HER2+ but later pathology has equivocal then negative. I initially bought a wig and got ready for chemo.)

I had a double mastectomy, then saw four oncologists at 4 different hospitals because I was troubled by the test ambiguity and contradictions and also by the recommendation to only do hormonal meds. The 4th doctor understood my dilemma and retested Oncotype and retested HER2 with more cells (60 versus 20) so I could feel more reassured.

I met with radiation oncology on my own and was told one in five radiation oncologists might suggest radiation for me. But there were risks to it for lungs and with lupus.

I did letrozole for 5 years. Then did a Breast Cancer Index (thanks to breastcancer.org since my docs did not use this; it is now part of the NCCN guidelines) which said no benefit to further meds. I am 8 years out.

I read that LVI is equivalent to one node positive. I also read that it matters whether it is "focal" or "extensive." I even wondered if the biopsy could have created the appearance of LVI.

The significance of LVI isn't what I thought. The significance is that these cells show a desire to "go somewhere" and have the ability to implant. I was told that everyone has cancer cells floating around but only some of the cells have the ability to create metastasis. This is from memory so ask a doc!

Keep going with opinions until you are satisfied! You have to send pathology slides around but it is worth it if you are not feeling comfy with treatment plan.