Microvessels that predict axillary lymph node metastases in patients with breast cancer.
OBJECTIVE
The density of vasoactive endothelial growth factor receptor 3-immunostained microvessels in primary breast cancers correlates with the incidence of axillary lymph node metastasis.


METHODS
Breast cancer microvessel clusters ("hot spots") were sequentially immunostained for factor VIII, type IV collagen, and vasoactive endothelial growth factor receptor 3. Microvessels were counted under light microscopy at a magnification of x 200. Axillary lymph nodes were evaluated for metastases by light microscopy.


METHODS
A multidisciplinary breast cancer clinic and laboratory.


METHODS
Sixty patients with T2 breast cancers treated by lumpectomy (or mastectomy) and axillary lymphadenectomy.


METHODS
Putative lymphatic microvessel density compared with axillary metastases.


RESULTS
There were 16% (SE, 1.4%) vs 4% (SE, 0.8%) vasoactive endothelial growth factor receptor 3-immunostained microvessels (P<.001), 38% (SE, 3.9%) vs 65% (SE, 3.1%) type IV collagen-immunostained microvessels (P<.001), and 46% (SE, 4.1%) vs 31% (SE, 3.2%) unstained microvessels (P = .004) in node-positive vs node-negative patients, respectively. A fitted logistic model based on the relative percentage of putative lymphatic microvessels to blood microvessels correctly predicted that 23 (96%) of 24 patients would have a low risk and that 26 (96%) of 27 patients would have a high risk of lymph node metastases. Six (67%) of 9 patients predicted to have an intermediate risk had lymph node metastases.


CONCLUSIONS
The odds of a patient with breast cancer having axillary lymph node metastasis increased substantially as the proportion of putative lymphatic microvessels increased and the relative proportion of blood microvessels in angiogenic hot spots decreased (log likelihood = 14.6; chi2 = 53.4; P<.001; area under the receiver operation characteristic curve = 0.97).
Nathanson
S D
SD
Department of Surgery, Henry Ford Health System, Detroit, Mich 48202, USA. dnathan1@hfhs.org
Zarbo
R J
RJ
Wachna
D L
DL
Spence
C A
CA
Andrzejewski
T A
TA
Abrams
J
J
D001943:Breast Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000098:blood supply*; D008207:Lymphatic Metastasis; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009389:Neovascularization, Pathologic / Q000473:pathology*; D020794:Receptor Protein-Tyrosine Kinases / Q000032:analysis; D011956:Receptors, Cell Surface / Q000032:analysis; D040321:Vascular Endothelial Growth Factor Receptor-3
D011956:Receptors, Cell Surface; D020794:Receptor Protein-Tyrosine Kinases; D040321:Vascular Endothelial Growth Factor Receptor-3