D-Dimer Levels In Breast Carcinoma: A Clinico-Pathologic Study

  • Sapna Patel Department of Pathology, JSS Medical College, JSS University, Sri Shivarathreeshwara Nagar Mysuru-570015 Karnataka, India
  • Rashmi C Department of Pathology, JSS Medical College, JSS University Sri Shivarathreeshwara Nagar Mysuru-570015 Karnataka, India
  • Harish S Department of Pathology, JSS Medical College, JSS University Sri Shivarathreeshwara Nagar Mysuru-570015 Karnataka, India
Keywords: Breast carcinoma, Fibrinolytic system, Axillary lymph node, D-dimer, Histopathological grading.

Abstract

Background:Breast cancer is the most common cause of death in women by neoplasia. Plasma D-dimer is a hypercoagulability and fibrinolytic system marker, which is produced when factor XIIIa (a cross-linked fibrin) is degraded by plasmin. It is increased in various solid tumour patients including breast, lung, prostate, cervical and colorectal cancers. Methods:30 patients of breast carcinoma who underwent radical mastectomy (cases) and 30 cases without carcinoma (controls) were included. The baseline parameters (D-dimer levels) were measured in both cases and controls. From each patient, whole blood was collected and Quantitative D-dimer levels were obtained by Diazyme’s D-dimer Assay using the instrument, RANDOX Rx imola. Other parameters such as histopathological features, hormonal receptors (ER & PR) and HER2/neu status were studied in cases.Result:Mean plasma D-dimer levels were significantly higher in patients with breast carcinoma before surgery as compared to after surgery (p<0.001).  Quantitative D-dimer levels highly correlated with lymph node status and histopathological grading (p=0.003, p=0.015 respectively).Conclusion: Our study showed that high plasma D-dimer levels can be used as a marker for lymph node involvement and higher histopathological grade. Due to the ease with which plasma D-dimer levels can be obtained and its cost effectiveness, quantitative D-dimer levels can be added to models for predicting axillary lymph node involvement.DOI:10.21276/APALM.1664

References

1. Batschauer AP, Figueiredo CP, Bueno EC, Ribiero MA, Dusse LMS, Fernandes AP et al. D-dimer as a possible prognostic marker of operable hormone receptor-negative breast cancer. Ann Oncol. 2010;21(6):1267-1272.

2. Khangarot SS, Gupta N, Goswami B, Hadke NS, Lal P, Gupta N et al. Correlation of D dimer and factor VIII levels with histopathology in patients with breast carcinoma. Cancer Biomark. 2010;7:305-314.

3. Ay C, Vormittag R, Dunkler D, Simanek R, Chiriac AL, Drach J et al. D-Dimer and Prothrombin Fragment 1+2 Predict Venous Thromboembolism in Patients With Cancer: Results From the Vienna Cancer and Thrombosis Study. J Clin Oncol. 2009;27(25):4124-4129.

4. 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):600-608.

5. Ahmed T, Ahmed RS, Basharat MU, Mushtaq MH, Gill SS, Khawaja AR et al. Comparative study to assess coagulation abnormalities in breast cancer. Adv.life sci. 2013;1(2):96-103.

6. Ay C, Dunkler D, Pirker R, Thaler J, Quehenberger P, Wagner O et al. High D-dimer levels are associated with poor prognosis in cancer patients. Haematologica. 2012;97(8):1158-1164.

7. Sitalakshmi S, Rameshkumar K, Damodar P. Significance of Haemostatic Markers in Ovarian Carcinoma. Indian J Med Paediatr Oncol. 2008;29(2):6-10.

8. Oya M, Akiyama Y, Okuyama T, Ishikawa H. High preoperative D dimer Level is Associated with Advanced Tumor Stage and Short Survival After Curative Resection in Patients with Colorectal Cancer. Jpn J Clin Oncol. 2001;31(8):388-394.

9. 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):389-395.

10. Liu L, Zhang X, Yan B, Gu Q, Zhang X, Jiao J et al. Elevated Plasma D-Dimer Levels Correlate with Long Term Survival of Gastric Cancer Patients. PLOS ONE. 2014;9(3):e90547.

11. Alcalay A, Wun T, Khatri V, Chew HK, Harvey D, Zhou H et al. Venous thromboembolism in patients with colorectal cancer: incidence and effect on survival. J Clin Oncol. 2006, 24(7):1112–1118.

12. Francis CW, Marder VJ. Mechanism of fibrinolysis. In: Coller B, editor. Williams hematology. 5th ed. New York: McGraw-Hill; 1995: 1252–1260.

13. Buccheri G, Torchio P, Ferrigno D. Plasma Levels of D-Dimer in Lung Carcinoma: Clinical and Prognostic Significance. Cancer. 2003;97(12):3044-3052.

14. Bogenrieder T, Herlyn M. Axis of evil: Molecular mechanisms of cancer metastasis. Oncogene. 2003;22:6524-6536.

15. Madkour BS; Bekheet IW, El Baz AG, Ghobashy S, El-Ganzory H, Essawy FM. Prognostic and Predictive Significance of Haemostatic and Angiogenic Parameters in Cancer Bladder Patients. J Am Sci. 2010;6(11):1091-1097.

16. Angenete E, Langenskiold M, Palmgren I, Falk P, Oresland T, Ivarsson ML. uPA and PAI-1 in rectal cancer-relationship to radiotherapy and clinical outcome. J Surg Res. 2009;153(1):46-53.

17. Langenskiold M, Holmdahl L, Angenete E, Falk P, Nordgren S, Ivarsson ML. Differential prognostic impact of uPA and PAI-1 in colon and rectal cancer. Tumour Biol. 2009;30(4):210-220.

18. Suega K, Bakta IM. Correlation Between Clinical Stage of Solid Tumor and D Dimer as a Marker of Coagulation Activation. Acta Med Indones. 2011;43(3):162-167.

19. Benoy IH, Salgado R, Elst H, Van Dam P, Weyler J, Van Marck E et al. Relative microvessel area of the primary tumour, and not lymph node status, predicts the presence of bone marrow micrometastases detected by reverse transcriptase polymerase chain reaction in patients with clinically non-metastatic breast cancer. Breast Cancer Res. 2005;7:210-221.

20. Xu G, Zhang YL, Huang W. Relationship between plasma D-dimer levels and clinicopathologic parameters in resectable colorectal cancer patients. World J Gastroenterol. 2004;10(6):922-923.

21. Kwon HC, Oh SY, Lee S. Plasma Levels of Prothrombin Fragment F1+2, D-dimer and Prothrombin Time Correlate with Clinical Stage and Lymph Node Metastasis in Operable Gastric Cancer Patients. Jpn J Clin Oncol. 2008;38(1):2-7
Published
2018-03-22
Section
Original Article