Tumor flow in malignant breast tumors measured by Doppler ultrasound: an independent predictor of survival

The purpose of this study was to investigate tumor blood flow in breast can cers with regard to its impact on the overall survival of patients. Tumor b lood flow was assessed in seventy-four patients with primary breast cancer by the use of color-coded Doppler ultrasound techniques. Preoperatively obt ained Doppler frequency spectra were analyzed for peak systolic flow veloci ty (V-max). Color Doppler signals were detected in 71 (96%) of the breast t umors. Out of 74 patients, 17 experienced a relapse or distant metastasis, and 15 women had died due to breast cancer at the time of data analysis. Th e mean V-max of the patients who had died was 0.27 m s(-1), whereas survivo rs showed a mean V-max of 0.16 m s(-1) (p = 0.01). V-max, nodal status, and progesterone receptor status remained the only sig nificant factors of overall survival in the multivariate model, whereas tum or size, tumor grade, and estrogen receptor status failed to retain prognos tic significance. Moreover, V-max was identified as the most important prog nostic marker for survival in our series. The five-year-survival was 82.3% in V-max less than or equal to 0.25 m s(-1) patients versus 36.6% in women with tumor flow greater than 0.25 m s(-1). Patients with V-max > 0.25 m s(- 1) experienced a 4.33-fold increased risk of death secondary to the underly ing disease. In summary, our data showed that tumor blood flow velocity measured by ultr asonography is an independent prognostic factor of survival in breast cance r patients. Furthermore, tumor flow velocity allows identification of patie nts at very high risk of death due to breast cancer. Large scale clinical t rials should evaluate the clinical usefulness and future impact of this pro cedure for adjuvant treatment decisions.