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Life sciences · Journal article
Archives of Pathology & Laboratory Medicine · October 29, 2026
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Context.— Residual pure intralymphatic carcinoma (PIC), defined as residual tumor confined exclusively to lymphovascular spaces without stromal invasion after neoadjuvant therapy (NAT), is a rare, residual disease pattern. No standardized staging, pathology reporting protocol, or consensus classification exists within current frameworks. Objective.— To characterize the clinicopathologic features, post-NAT staging, Residual Cancer Burden (RCB) classification, and outcomes of patients with PIC at our institution, and to perform a pooled analysis of all published cohorts. Design.— This is a retrospective cohort study of consecutive patients with breast cancer treated with NAT and surgery at a large academic medical center from January 2015 to September 2025. Identified PIC cases were systematically characterized and compared against 5 previously published cohorts. Results.— Of 2000 patients screened, 13 (0.65%) had PIC (9 of 13 [69%] grade 3; 7 of 13 [54%] human epidermal growth factor receptor 2 [HER2]–positive). All had ypT0 disease (yp denotes pathologic stage after neoadjuvant therapy) on American Joint Committee on Cancer (AJCC) staging, while 8 of 13 node-negative patients (62%) may have an RCB score of RCB-I or higher when intralymphatic tumor dimensions are entered—a framework mismatch rather than true pathologic complete response (pCR). At median follow-up of 59.2 months, overall survival was 100% (13 of 13) and disease-free survival, was 92% (12 of 13). Pooled analysis (N = 60) showed mortality decline from 83% (5 of 6) in the earliest (pre-2018) cohort to 0% to 20% post-2018. Conclusions.— Current staging frameworks may misclassify PIC as pCR, implying incomplete standardization with potential clinical consequences. We propose an AJCC modifier, ypT0(LVI + ), for residual lymphovascular invasion in the absence of residual in situ carcinoma or nodal metastasis, plus a dedicated College of American Pathologists synoptic field to ensure appropriate management.