BREAST-CANCER ANGIOGENESIS - A QUANTITATIVE MORPHOLOGIC AND DOPPLER IMAGING STUDY

Background: Tumor growth and metastases require the development of new vessels (angiogenesis). Angiogenesis, assessed by microvessel count u sing immunocytochemical stain of endothelial cells, has been shown to predict metastases and correlate with early death. Recently developed color Doppler mapping can detect the ''tumor flow signals'' in breast cancer and help to distinguish it from benign lesions. The question is , does this tumor vascularization assessed by color Doppler mapping co rrelate with the angiogenesis assessed by immunocytochemistry? Methods : Eighty-four patients admitted for breast surgery were studied. The f inal diagnosis was made by pathology for 52 malignancies and 32 benign lesions. The color Doppler mapping of the breast lesion was made preo peratively. The following parameters were assessed: (a) vessel locatio n (peripheral or central); Cb) density of color Doppler signals; and ( c) maximum systolic velocity. Tumor angiogenesis was assessed by micro vessel count under light microscopy using the platelet/endothelial cel l adhesion molecule antibodies (CD31) method. The correlation between maximum velocity and microvessel count of breast cancer was examined, The clinical significance of maximum flow velocity of breast cancer wi th various clinicopathologic factors was assessed. Results: Color sign als were detected in 48 cases of 52 malignancies (92%). All tumors dem onstrated signals at the periphery of the lesion but in only 13 (27%) were the signals detected within the tumor. Color signals were scored as ++ or +++ in 44 (92%) patients. Pulsed wave blood flow was shown in all these 48 tumors, with maximum velocities varying from 4 to 36 cm/ s, Among the 32 benign lesions, color signals were detected in 10 (31% ) and all were peripheral and scored subjectively as +. Evaluation of these color Doppler mapping parameters shows no significant correlatio n with microvessel counts using CD31 monoclonal antibodies. However, t here was a positive association (p < 0.05) between nodal metastases an d higher tumor flow velocity in T1 (<2 cm) breast tumors but not in la rger tumors. Conclusion: Although the color Doppler mapping has been s hown to be useful in distinguishing benign from malignant breast lesio ns, the intensity of signal and velocity of flow had no correlation wi th the extent of angiogenesis of breast cancer. The presence of high-f low tumor signal in early breast carcinoma is significantly associated with the presence of axillary lymph node metastases.