title: Vascularization in primary breast carcinomas: its prognostic significance and relationship with tumor cell dissemination.
abstract: OBJECTIVE
  The interaction between tumor cells, stroma, and endothelial cells is important for the dissemination of tumor cells. The aim of the present study is to examine vascularity in primary breast carcinomas and its prognostic significance and relationship with tumor cell dissemination.
  
  
  METHODS
  A total of 498 invasive breast carcinomas were analyzed. Representative tumor sections were stained for CD34 and CD105, and vascularity was quantified by the Chalkley method. The relationship between Chalkley counts, vascular invasion, disseminated tumor cells (DTC) in the bone marrow, other clinicopathologic variables, and clinical outcome was evaluated.
  
  
  RESULTS
  High vascular grades determined by Chalkley counts were significantly associated with shorter distant disease-free survival and breast cancer-specific survival in all patients (P < 0.001, log-rank) and in node-negative patients not receiving adjuvant systemic therapy (P < 0.05). In multivariate analysis, both CD34 and CD105 Chalkley counts showed prognostic significance for distant disease-free survival (P = 0.014 and P = 0.026), whereas CD34 also showed prognostic significance for breast cancer-specific survival (P = 0.007). Vascular invasion and DTCs in the bone marrow showed independent prognostic significance. DTC did not discriminate survival for CD34 low Chalkley counts, whereas a very poor prognosis was observed for DTC-positive patients with high CD34 counts. In node-negative patients not receiving systemic chemotherapy, high CD34 and high CD105 counts in combination identified patients with unfavorable outcome, as opposed to all other CD34/CD105 combinations.
  
  
  CONCLUSIONS
  Improved identification of risk groups could be obtained by adding CD34 and CD105 vascular analysis to DTC, vascular invasion, and other primary tumor factors. This may facilitate the selection of candidates for adjuvant systemic therapy.
authors.affiliation: Pathology Laboratories, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Montebello, Oslo, Norway.
authors.forename: Hari Prasad
authors.initials: HP
authors.lastname: Dhakal
authors.forename: Bjørn
authors.initials: B
authors.lastname: Naume
authors.forename: Marit
authors.initials: M
authors.lastname: Synnestvedt
authors.forename: Elin
authors.initials: E
authors.lastname: Borgen
authors.forename: Rolf
authors.initials: R
authors.lastname: Kaaresen
authors.forename: Ellen
authors.initials: E
authors.lastname: Schlichting
authors.forename: Gro
authors.initials: G
authors.lastname: Wiedswang
authors.forename: Assia
authors.initials: A
authors.lastname: Bassarova
authors.forename: Karl-Erik
authors.initials: KE
authors.lastname: Giercksky
authors.forename: Jahn M
authors.initials: JM
authors.lastname: Nesland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000032:analysis; D018952:Antigens, CD34 / Q000032:analysis; D001943:Breast Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000473:pathology; D000071063:Endoglin; D005260:Female; D006801:Humans; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology*; D011379:Prognosis; D011956:Receptors, Cell Surface / Q000032:analysis
chemical_list: D015703:Antigens, CD; D018952:Antigens, CD34; C064206:ENG protein, human; D000071063:Endoglin; D011956:Receptors, Cell Surface