Hypervascularity Predicts Complete Pathologic Response to Chemotherapy and Late Outcomes in Breast Cancer.

Abstract

BACKGROUND:

Our objective was to investigate the relationship between asymmetric increase in breast vascularity (AIBV) and pathologic profiles of breast cancer. We also addressed the prognostic performance of AIBV and of vascular maps reduction after neoadjuvant chemotherapy (NAC) in predicting pathologic complete response (pCR) at surgery and outcome at follow-up.

MATERIALS AND METHODS:

Two hundred nineteen patients with unilateral locally advanced breast cancer (LABC) underwent magnetic resonance imaging before and after NAC. Axial, sagittal, and coronal maximum intensity projections were obtained in a subjective comparative evaluation. Asymmetrical versus symmetrical breast vascularity was defined through number of vessels, diameter, and signal intensity. Kaplan-Meier methodology was employed for late survival (31.4 ± 18 months follow-up).

RESULTS:

AIBV ipsilateral to LABC occurred in 62.5% (P < .001). AIBV was significantly associated with invasive ductal carcinoma, G3, triple-negative, HER2+, and hybrid phenotypes (P < .001). pCR was more frequent among patients with AIBV (24%) (P = .001). After NAC, the vascular map was significantly reduced, particularly in patients with pCR (P < .001). At follow-up, the recurrence rate was 22% (6.1% mortality). AIBV after NAC was associated with worse late survival (P = .036). A trend towards worse late survival existed among patients with AIBV before NAC. We did not observe statistically different survival according to the variation of vascularity after NAC.

CONCLUSION:

LABC with ipsilateral AIBV before NAC is associated with more aggressive pathologic profiles. Nonetheless, it is more sensitive to NAC and shows a higher frequency of pCR. The persistence of AIBV after NAC entails a worse late prognosis and should prompt more aggressive therapeutic strategies.

• Authors: Enida Bufi, Paolo Belli, Marialuisa Di Matteo, Michela Giuliani, Mariavalentina Tumino, Pierluigi Rinaldi, Luigia Nardone, Gianluca Franceschini, Antonino Mulé, Lorenzo Bonomo
• Journal: Clinical breast cancer (Clin Breast Cancer) Vol. 16 Issue 6 Pg. e193-e201 (12 2016) ISSN: 1938-0666 [Electronic] United States
• PMID: 27431459 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Contrast Media
• Receptors, Estrogen
• Receptors, Progesterone
• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Biopsy, Large-Core Needle
• Breast (blood supply, diagnostic imaging, pathology)
• Breast Neoplasms (blood supply, drug therapy, mortality, pathology)
• Carcinoma, Ductal, Breast (blood supply, drug therapy, mortality, pathology)
• Contrast Media (administration & dosage)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Magnetic Resonance Angiography
• Middle Aged
• Neoadjuvant Therapy (methods)
• Neoplasm Recurrence, Local (blood supply, epidemiology, pathology)
• Neoplasm Staging
• Prognosis
• Receptor, ErbB-2 (metabolism)
• Receptors, Estrogen (metabolism)
• Receptors, Progesterone (metabolism)
• Retrospective Studies
• Treatment Outcome