title: Hypervascularity Predicts Complete Pathologic Response to Chemotherapy and Late Outcomes in Breast Cancer.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.affiliation: Department of Radiological Sciences, Catholic University, Rome, Italy. Electronic address: reagandus@alice.it.
authors.forename: Enida
authors.initials: E
authors.lastname: Bufi
authors.affiliation: Department of Radiological Sciences, Catholic University, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Belli
authors.affiliation: Department of Radiological Sciences, Catholic University, Rome, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Di Matteo
authors.affiliation: Department of Radiological Sciences, Catholic University, Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Giuliani
authors.affiliation: Department of Radiological Sciences, Catholic University, Rome, Italy.
authors.forename: Mariavalentina
authors.initials: M
authors.lastname: Tumino
authors.affiliation: Department of Radiological Sciences, Catholic University, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Rinaldi
authors.affiliation: Department of Radiotherapy, Catholic University, Rome, Italy.
authors.forename: Luigia
authors.initials: L
authors.lastname: Nardone
authors.affiliation: Department of Surgery, Breast Unit, Catholic University, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Franceschini
authors.affiliation: Department of Pathology, Catholic University, Rome, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Mulé
authors.affiliation: Department of Radiological Sciences, Catholic University, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000098:blood supply* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000098:blood supply* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Breast tumor; Increased vascularization; Magnetic Resonance Imaging; Neoadjuvant chemotherapy; Prognosis