Correlation of plasma D-dimer levels with breast carcinoma
Keywords:Breast carcinoma, D-dimer, Advanced stage, Lymphovascular invasion
Background: Breast cancer is the most commonly occurring cancer in women. There is a correlation between cancer and hyper coagulation. Carcinoma increases the level of cross-linked fibrin degradation product (plasma D-dimer), indicative of systemic activation of fibrinolysis, hemostasis and angiogenesis. This study attempted to correlate raised plasma D-dimer in breast cancer.
Methods: A retrospective study was conducted in the department of general surgery in GCS hospital, Ahmedabad where in patients admitted and treated for breast cancer between July 2020 to June 2021 were selected. Plasma D-dimer levels were correlated with final histopathological examination of breast specimen.
Results: Plasma D-dimer levels were increased with advancing stage of disease, lymph node involvement and lymphovascular invasion. There was no significant relationship with increase in tumour size and histopathological grade of tumour.
Conclusions: Plasma D-dimer levels are elevated in breast cancer, especially with advanced stage. It is an important marker of clinical stage, lymphovascular invasion, lymph node involvement. However it does not correlate with tumour size and histological grade. So pre- operative plasma D-dimer level is a safe, cost effective and convenient method for prediction of advanced stage in breast cancer.
World Cancer Research Fund International. Fact sheet: Breast cancer statistics. Available at: https://www.wcrf.org/dietandcancer/breast-cancer-statistics/ Data accessed on 1 October 2021.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.
Trousseau A. Phlegmasia alba dolens. Lectures on Clinical Medicine at the Hotel-Dieu, Paris. London: New Sydenham Society; 1872: 281-332.
Falanga A, Rickles FR. Pathophysiology of the thrombophilic state in the cancer patient. Semin Thromb Hemost. 1999;25(2):173-82.
Dvorak HF, Brown LF, Detmar M, Dvorak AM. Vascular permeability factor/vascular endothelial growth factor, microvascular hyperpermeability, and angiogenesis. Am J Pathol. 1995;146(5):1029-39.
Knowlson L, Bacchu S, Paneesha S, McManus A, Randall K, Rose P. Elevated D-dimers are also a marker of underlying malignancy and increased mortality in the absence of venous thromboembolism. J Clin Pathol. 2010;63(9):818-22.
Green D, Maliekel K, Sushko E, Akhtar R, Soff GA. Activated-protein-C resistance in cancer patients. Haemostasis. 1997;27(3):112-8.
Dirix LY, Salgado R, Weytjens R, Colpaert C, Benoy I, Huget P, et al. Plasma fibrin D-dimer levels correlate with tumour volume, progression rate and survival in patients with metastatic breast cancer. Br J Cancer. 2002;86(3):389-95.
Bhavesh D, Dev NK, Sudershan S, Jaswal S. Evaluation of plasma D-dimer level as a predictive marker of advanced carcinoma breast. J Clin Case Rep. 2015;5:547.
Ghadhban BR. Plasma d-dimer level correlated with advanced breast carcinoma in female patients. Ann Med Surg. 2018;36:75-8.
Sringeri RR, Chandra PS. Role of plasma D-dimer levels in breast cancer patients and its correlation with clinical and histopathological stage. Indian J Surg Oncol. 2018;9(3):307-11.
Rajendran G, Aravind D, Venkatesh P, Anandan H. Correlation of coagulation markers with axillary lymph node metastasis in carcinoma breast. Int Surg J. 2018;5:1394-8.
Blackwell K, Haroon Z, Broadwater G, Berry D, Harris L, Iglehart JD, et al. Plasma D-dimer levels in operable breast cancer patients correlate with clinical stage and axillary lymph node status. J Clin Oncol. 2000;18(3):600-8.