IV-DSA is a new diagnostic tool for axillary lymph node metastasis in breast cancer patients.
OBJECTIVE
The aim of this study is to know whether intravenous digital subtraction angiography (IV-DSA) is useful to detect axillary lymph node metastasis of breast cancer and to evaluate the anigiogenesis of lymph nodes in the axilla.


METHODS
Forty three primary breast cancer patients (N0: 26 cases, N1: 5 cases, N2: 2 cases) who underwent IV-DSA between January and November 2000 were included in the study. Infinix CB apparatus (Toshiba, Japan) was used to collect IV-DSA images and when a mass became stained in the axilla, it was considered to be metastatic. The angiogenesis was studied by examining microvessel density (MVD) after lymph node immunostaining for factor VIII. Primary tumor was detected by IV-DSA in all 43 cases.


RESULTS
Axillary lymph node metastases were detected by IV-DSA in 34.9% of cases (15/43), and by pathology in 37.2% (16/43). The sensitivity, specificity, and accuracy of the diagnostic method were 75.0% (12/16), 88.9% (24/27), and 83.7% (36/43), respectively. MVD, calculated after immunostaining for factor VIII, was significantly lower in the in metastatic region of lymph nodes identified by DSA (88.5 +/- 35.0) than in metastasis-free lymph nodes (141.1 +/- 34.0, P < 0.0001).


CONCLUSIONS
IV-DSA is useful in the diagnosis of axillary lymph node metastasis of breast cancer. Our results suggest that the primary factors involved in the mechanism of DSA display may be different from high/low MVC values.
Watanabe
Osamu
O
Department of Surgery, Tokyo Women's Medical University Daini Hospital, Tokyo, Japan. watanosu@dnh.twmu.ac.jp
Shimizu
Tadao
T
Imamura
Hiroshi
H
Kinoshita
Jun
J
Utada
Yoshihito
Y
Okabe
Toshihiro
T
Kimura
Kiyomi
K
Hirano
Akira
A
Aiba
Motohiko
M
Ogawa
Kenji
K
D015901:Angiography, Digital Subtraction; D001365:Axilla; D001943:Breast Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology*; D005169:Factor VIII / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity
D005169:Factor VIII