From American Journal of Roentgenology

Correlation of Whole-breast Vascularity With Ipsilateral Breast Cancers Using Contrast-enhanced MDCT

Doo Kyoung Kang; Eun Jin Kim; Ho Sung Kim; Joo Sung Sun; Yong Sik Jung

Posted: 04/25/2008; Am J Roentgenol. 2008;190(2):496-504. © 2008 American Roentgen Ray Society

 

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Abstract and Introduction

Abstract

Objective: The purpose of our study was to assess the increase in whole-breast vascularity in patients with unilateral breast cancer and correlate that increase with prognostic factors of breast cancer.
Materials and Methods: We performed 16-MDCT on 143 consecutive patients with histologically confirmed breast cancer. One hundred three of these 143 patients were finally enrolled in the study after exclusion of patients with bilateral breast cancer, previous history of neoadjuvant chemotherapy, breast surgery, or lack of surgical confirmation. Breast vascularity was assessed according to the number, length, and conspicuity of vessels on maximum-intensity-projection images. Increase of whole-breast vascularity of the cancer-bearing breast was categorized as not increased, mild, moderate, or prominent compared with the contralateral breast. Breast vascularity was then correlated to prognostic factors including tumor size, lymph node status, cancer stage, nuclear and histologic grade, presence of an extensive intraductal component, presence of hormone receptors, and expression of C-erb-B2.
Results: In 77 (74.8%) of 103 patients, breast cancers were found to be associated with ipsilateral increased whole-breast vascularity. In the 77 patients with increased vascularity, prominent, moderate, and mild vascularity were shown in 21 (27.3%), 23 (29.9%), and 33 (42.9%) patients, respectively. Ipsilateral increased vascularity was related to tumor size, lymph node status, cancer stage, nuclear grade, and histologic grade. The presence of extensive intraductal component and hormone receptors and the expression of C-erb-B2 were not related to ipsilateral increased vascularity.
Conclusion: Breast cancers were found to be associated with ipsilateral increased whole-breast vascularity in a significant percentage of patients. Increased whole-breast vascularity indicated the growth and metastatic potential of a breast cancer.

Introduction

Angiogenesis (also known as neovascularization) is the formation of new capillaries from the existing vascular network.[1] Because vascular blood flow provides nutrients for tumor growth and a mechanism for hematogenous spread of malignant cells,[2,3] tumor angiogenesis has been reported to be an independent prognostic indicator in breast cancer.[4-8] Although tumor vasculature has mostly been investigated by immunohistochemical methods using factor VIII staining of endothelial cells to determine microvessel density (MVD),[9,10] this invasive method is difficult to reproduce and standardize.[11] Many imaging angiogenesis methods in vivo have recently been developed, including color Doppler sonography[12] and contrast-enhanced MRI,[13,14] and most of them have focused on measurement of angiogenesis in the immediate vicinity of the growing tumor. However, vascularity can increase not only within a breast cancer lesion but also in the ipsilateral breast as a whole. Recently, some studies have estimated whole-breast vascularity by laser Doppler perfusion imaging,[15] PET,[16] and MRI[17-19] and found an association between breast cancer and an ipsilateral increase of blood flow.

Although contrast-enhanced CT of the breast has been used for assessment of axillary lymph node metastasis,[20,21] diagnosis of local recurrence after breast-conserving surgery,[22] or imaging intraductal extension of breast cancer preoperatively,[23] it can also show tumor vascularity. Especially, MDCT can display high-quality angiographic images because of improved temporal and spatial resolution. However, to the best of our knowledge, there has been no study on imaging vascularity of breast cancer using contrast-enhanced MDCT. The purpose of this study was to quantitatively evaluate ipsilateral whole-breast vascularity using MDCT in patients with unilateral breast cancer and correlate it with prognostic factors of breast cancer.

 
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References

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Table 1. Characteristics of Study Population (n = 103)

Characteristic Value
Age
Median (y) 46.7
Range (y) 22-79
Location of cancer
Right breast 41 (39.8)
Left breast 62 (60.2)
Cancer stage
0 2 (1.9)
I 27 (26.2)
IIA 23 (22.3)
IIB 22 (21.4)
IIIA 11 (10.7)
IIIB 2 (1.9)
IIIC 16 (15.5)
Histopathology
Invasive ductal cacinoma, NOS 88 (85.4)
Mucinous carcinoma 4 (3.9)
Medullary carcinoma 2 (1.9)
Metaplastic carcinoma 1 (1.0)
DCIS with microinvasion 6 (5.8)
DCIS 2 (1.9)
Surgery
Mastectomy
Radical mastectomy 10 (9.7)
Modified radical mastectomy 36 (35.0)
Total mastectomy 20 (19.4)
Breast-conserving surgery
Partial mastectomy 29 (28.2)
Lumpectomy 7 (6.8)
Excision 1 (1.0)

 

Data in parentheses are percentages. NOS = not otherwise specified, DCIS = ductal carcinoma in situ.

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Table 2. Correlation Between Ipsilateral Increased Vascularity and BI-RADS Descriptors

CT Findings Vascularity p
Not Increased (n = 26) Mild (n = 33) Moderate (n = 23) Prominent (n = 21)
Mass (n = 88) 23 28 18 19 0.744
Shape
Oval 6 1 1 3 0.132
Round 8 9 2 4  
Lobular 2 5 2 4  
Irregular 7 13 13 8  
Margin
Smooth 1 2 1 2 0.383
Irregular 13 7 8 7  
Spiculated 9 19 9 10  
Mass enhancement
Homogeneous 7 10 4 3 0.448
Heterogeneous 5 9 6 10  
Rim enhancement 11 9 8 6  
Nonmasslike enhancement (n = 15) 3 5 5 2 0.744
Distribution modifiers
Segmental 3 3 4 1 0.670
Regional   2 2 1  
Internal enhancement
Homogeneous 1 2 2   0.947
Heterogeneous   1 1    
Clumped 2 2 2 2  
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Table 2. Correlation Between Ipsilateral Increased Vascularity and BI-RADS Descriptors

CT Findings Vascularity p
Not Increased (n = 26) Mild (n = 33) Moderate (n = 23) Prominent (n = 21)
Mass (n = 88) 23 28 18 19 0.744
Shape
Oval 6 1 1 3 0.132
Round 8 9 2 4  
Lobular 2 5 2 4  
Irregular 7 13 13 8  
Margin
Smooth 1 2 1 2 0.383
Irregular 13 7 8 7  
Spiculated 9 19 9 10  
Mass enhancement
Homogeneous 7 10 4 3 0.448
Heterogeneous 5 9 6 10  
Rim enhancement 11 9 8 6  
Nonmasslike enhancement (n = 15) 3 5 5 2 0.744
Distribution modifiers
Segmental 3 3 4 1 0.670
Regional   2 2 1  
Internal enhancement
Homogeneous 1 2 2   0.947
Heterogeneous   1 1    
Clumped 2 2 2 2  
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Table 3. Correlation Between Ipsilateral Increased Vascularity and Histopathologic Predictors

Variable Vascularity p
Not Increased (n = 26) Mild (n = 32) Moderate (n = 22) Prominent (n = 21)
Mean age (y) 43.7 48.9 44.5 49.2 0.156
T stage
T1 (n = 40) 15 (37.5) 14 (35.0) 9 (22.5) 2 (5.0) 0.009
T2 (n = 51) 11 (21.6) 16 (31.4) 11 (21.6) 13 (25.5)  
T3 (n = 7)   2 (28.6) 1 (14.3) 4 (57.1)  
T4 (n = 3)     1 (33.3) 2 (66.7)  
N stage
N0 (n = 44) 19 (43.2) 10 (22.7) 9 (20.5) 6 (13.6) 0.003
N1 (n = 29) 6 (20.7) 10 (34.5) 8 (27.6) 5 (17.2)  
N2 (n = 12) 1 (8.33) 5 (41.7) 4 (33.3) 2 (16.7)  
N3 (n = 16)   7 (43.8) 1 (6.25) 8 (50.0)  
Stage
I (n = 27) 14 (51.9) 6 (22.2) 6 (22.2) 1 (3.7) 0.001
II (n = 45) 11 (24.4) 14 (31.1) 10 (22.2) 10 (22.2)  
III (n = 29) 1 (3.5) 12 (41.4) 6 (20.7) 10 (34.5)  
Nuclear grade
1 (n = 39) 5 (12.8) 11 (28.2) 9 (23.1) 14 (35.9) 0.046
2 (n = 40) 12 (30.0) 14 (35.0) 9 (22.5) 5 (12.5)  
3 (n = 9) 4 (44.4) 4 (44.4) 1 (11.1)    
Histologic grade
1 (n = 12) 3 (23.1) 7 (53.8) 3 (23.1)   0.008
2 (n = 30) 10 (33.3) 6 (20.0) 10 (33.3) 4 (13.3)  
3 (n = 46) 7 (15.6) 16 (35.6) 6 (13.3) 16 (35.6)  
Extensive intraductal component (n = 34) 8 (23.5) 11 (32.4) 10 (29.4) 5 (14.7) 0.582
Hormone receptor
Estrogen receptor (n = 65) 17 (26.2) 22 (33.8) 15 (23.1) 11 (16.9) 0.736
Progesterone receptor (n = 64) 17 (26.6) 23 (35.9) 15 (23.4) 9 (14.1) 0.234
C-erb B oncogene (n = 56) 13 (23.2) 19 (33.9) 11 (19.6) 13 (23.2) 0.746

 

Unless otherwise indicated, data in parentheses are percentages.

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Authors and Disclosures

Doo Kyoung Kang,1 Eun Jin Kim,1 Ho Sung Kim,1 Joo Sung Sun,1 Yong Sik Jung 2

1Department of Diagnostic Radiology, Ajou University School of Medicine, Suwon, Kyongi-do, South Korea
2Department of General Surgery, Ajou University School of Medicine, Suwon, Kyongi-do, South Korea

 

 
 
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