Having read some of the replies to this topic, I thought I’d share my understanding when it comes to LVI, as I too found out that it was present purely by chance when reading the clinic letter that was sent to my GP after my first biopsy result (Clinical staging: Grade 2, IDC, ER+ PR+, HER2-, LVI+) came back and subsequently saw it mentioned in my post surgery histopathology report (Pathological staging: Grade 2, IDC, ER+ PR+, HER2-, LVI+, PI+, 1LN+).
My experience was also that neither the BCN/BC surgeon or Oncologist mentioned this during any of my appointments (i.e. it isn’t used as a pathological factor for treatment planning). And I can totally relate to the feeling of not being given all the information available at the time (pulling teeth was the word I used during my journey). But I raised it with my oncologist later because I had already looked up the term (I didn’t google, I just went to recognised medical sites for information), and had gone through my histopathology report with a pathologist - I’ve always been analytically minded and that came through in my BC diagnosis and treatment journey where I raised questions along the way.
My oncologist referenced various clinical trial results when explaining the treatment options she recommended for my tumour profile, and said that LVI wasn’t a factor that they would use on its own to alter/determine a treatment plan unless there were other clinical (symptoms or scans) or pathological (tumour profile) factors which indicated possible metastatic BC. I had two thorax abdo pelvis ct scan’s (also referred to as full body scan); the first when 1 of 4 lymph nodes came back positive at the time of my SLNB to determine what the next leg of treatment would be (chemo, radio, surgery etc…); the second was after my axillary dissection surgery when I had an elevated ALT (blood test result). The first CT result came back clear giving me the option to either have radiotherapy to the axilla or axillary dissection surgery. I chose the latter where 25 lymph nodes were removed, and none came back positive. The elevated ALT result was found to be due to my liver being overly sensitive to the anaesthetic and antibiotic drugs (this is apparently a known side effect in some patients) that were given during each of my surgeries (MX & ALND). This was proven by repeating the liver function blood test a couple of times after each surgery and observing the drop in ALT levels after each. I asked my oncologist if there was any method for detecting circulating cancer cells in the bloodstream. She said that there are certain tests but that there isn’t sufficient data to interpret the output yet as clinical trials haven’t been done/concluded - so effectively the answer was no. The reason why CT / PET CT scan’s aren’t repeated frequently unless there are clinical and pathological factors is because we get exposed to more radiation each time, however small that is. It’s the risk vs. reward debate, which applies to each of us along this journey. E.g. I wasn’t offered chemo as the risk outweighed the reward (low oncotype score).
I am now two years post diagnosis and had my second mammogram last month. One thing I have done and continue to do is advocate for myself at every step of the way. E.g. I have requested 3D mammograms instead of the standard 2D due to breast density, Ultrasound of both left & right axilla’s at the time of mammogram.
I have also been undergoing additional surveillance via Chest CT every 6 months for 2 years after a tiny benign nodule was observed on one of my lungs (from the first CT scan result done at the time of diagnosis). I still maintain my notebook and raise questions with my oncologist when needed, so please do advocate for yourself when you feel like you need to - i.e. aren’t getting the information you need.
Hoping that some the above information helps. I am learning to live more in the moment, and can say that it is getting easier with time. xx
I was diagnosed tnbc June 2017 no node involvement but LVI when I mentioned seeing the LVi when I first saw my oncologist he said don’t worry about that so I didn’t. Had 3 fec, 2 docetaxol and 1 fec. But when you see it in black and white in your letter then you Google it and go into orbit which was what I’d done before my oncologist said don’t worry about that 
