Hypervascularity predicts complete pathological response to chemotherapy and late outcomes in breast cancer

• Published in: Clinical breast cancer
• Main Authors: Bufi, Enida, MD, Belli, Paolo, MD, Di Matteo, Marialuisa, MD, Giuliani, Michela, MD, Tumino, Valentina, MD, Rinaldi, Pierluigi, MD, Nardone, Luigia, MD, Franceschini, Gianluca, MD, Mulé, Antonino, MD, Bonomo, Lorenzo, MD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Hematology, Oncology and Palliative Medicine; Obstetrics and Gynecology; Neoadjuvant chemotherapy; Prognosis; Hypervascularity
• ISSN: 1526-8209
• DOI: 10.1016/j.clbc.2016.06.007

Abstract Background Our objective was to investigate the relationship between asymmetric increase in breast vascularity (AIBV) and pathological profiles of breast cancer. We also addressed the prognostic performance of AIBV and of vascular maps reduction after Neoadjuvant Chemotherapy (NAC) in predicting pathological 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 MRI before and after NAC. Axial, sagittal and coronal MIPs were obtained in a subjective comparative evaluation. Asymmetrical vs. 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<0.001). AIBV was significantly associated with IDC, G3, Triple Negative, HER2+ and Hybrid phenotypes (p<0.001). pCR was more frequent among patients with AIBV (24%) (p= 0.001). After NAC, vascular map was significantly reduced, particularly in patients with pCR (p< 0.001). At follow-up, the recurrence rate was 22% (6.1% mortality). AIBV after NAC was associated with worse late survival (p=0.036). 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 pathological 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.