Skip to main content
Log in

Predication of axillary lymph node metastasis by intravenous digital subtraction angiography in breast cancer, its correlation with microvascular density

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Accurate predication of axillary node status by non-invasive diagnostic method would be of great value in cases of breast cancer. There have been few reports advocating digital subtraction angiography (DSA) as specifically advantageous for the detection of lymph node metastasis. IV (intravenous)-DSA was carried out on 42 patients with breast carcinoma using a DSA system with a matrix of 1024 × 1024×pixels. When a mass became stained in the axilla, it was considered to be metastatic. An immunohistochemical technique with JC70 antibody to platelet/endothelial cell adhesion molecules was used to evaluate the microvascular density (MVD) of the axillary lymph nodes. IV-DSA achieved a 76.2% sensitivity, 85.7% specificity, and 81.0% accuracy. The average MVD with JC70 antibody was 97.7 ± 44.4 in metastatic and 62.9 ± 23.6 in nonmetastatic nodes. MVD was significantly higher in the cancerous than in the noncancerous regions within lymph nodes. The MVD was 105 ± 38.4 in DSA-N(+) cases and was 57.8 ± 21.9 in DSA-N(−) cases, and the difference was statistically significant. In conclusion, IV-DSA is a useful diagnostic modality for detection of axillary lymph node metastasis. This new modality predicts lymph node status by assessing the neovascularization of the lymph node.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Fisher B, Bauer M, Wickerham L, Redmond C, Fisher E: Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. Cancer 52: 1551–1557, 1983

    Google Scholar 

  2. Fisher ER: Pathologic findings from the National Surgical Adjuvant Project for breast cancers. Cancer 53: 712–723, 1984

    Google Scholar 

  3. Walsh R, Kornguth PJ, Soo MS, Bentley R, DeLong DM: Axillary lymph nodes: mammographic, pathologic, and clinical correlation. AJR 168(1): 33–38, 1997

    Google Scholar 

  4. Tohnosu N, Okuyama K, Koide Y, Kikuchi T, Awano T, Matsubara H, Sano T, Nakaichi H, Funami Y, Matsushita M: A comparison between ultrasonography and mammography, computed tomography and digital subtraction angiography for the detection of breast cancers. Surgery Today 23(8): 704–710, 1993

    Google Scholar 

  5. March DE, Wechsler RJ, Kurtz AB, Rosenberg AL, Needleman L: CT-pathologic correlation of axillary lymph nodes in breast carcinoma. J Computer Assisted Tomography 15(3): 440–444, 1991

    Google Scholar 

  6. Miyauchi M, Yamamoto N, Imanaka N, Matsumoto M: Computed tomography for preoperative evaluation of axillary nodal status in breast cancer. Breast Cancer 6(3): 243–248, 1999

    Google Scholar 

  7. de Freitas R Jr. Costa MV, Schneider SV, Nicolau MA, Marussi E: Accuracy of ultrasound and clinical examination in the diagnosis of axillary lymph nodes in breast cancer. Eur J Surg Oncol 17: 240–244, 1991

    Google Scholar 

  8. Mustonen P, Farin P, Kosunen O: Ultrasonographic detection of metastatic axillary lymph nodes in breast cancer. Ann Chir Gynaecol 79: 15–18, 1990

    Google Scholar 

  9. Tate JJ, Lewis V, Archer T, Guyer PG, Royle GT, Taylor I: Ultrasound detection of axillary lymph node metastasis breast cancer. Eur J Surg Oncol 15: 139–141, 1989

    Google Scholar 

  10. Mussurakis S, Buckley DL, Horsman A: Prediction of axillary lymph node status in invasive breast cancer with dynamic contrast-enhanced MR imaging. Radiology 203(2): 317–321, 1997

    Google Scholar 

  11. Yoshimura G, Sakurai T, Oura S, Suzuma T, Tamaki T, Umemura T, Kokawa Y, Yang Q: Evaluation of axillary lymph node status in breast cancer with MRI. Breast Cancer 6(3): 249–258, 1999

    Google Scholar 

  12. Watt AC, Ackerman LV, Shetty PC, Burke M, Flynn M, Grodsinsky C, Fine G: Differentiation between benign and malignant disease of the breast using digital subtraction angiography of the breast. Cancer 56(6): 1287–1292, 1985

    Google Scholar 

  13. Watanabe O, Haga S, Shimizu T, Imamura H, Kobayashi K, Kinoshita J, Kajiwara T, Fujibayashi M: Relationship between staining by digital subtraction angiography and vascularity in breast cancer: analysis of the time-density curve and the results of staining for factor VIII-related antigen/von Willebrand factor. Breast Cancer Res Treat 33(3): 269–273, 1995

    Google Scholar 

  14. Bjoerk L, Leven H: Intra-arterial DSA and duplex-sonography in detection of vascularized inguinal lymph node. Acta Radiol 31: 106–107, 1990

    Google Scholar 

  15. Weidner N, Semple JP, Welch WR, Folkman J: Tumor angiogenesis and metastasis - correlation in invasive breast carcinoma. New England J Medicine 324(1): 1–8, 1991

    Google Scholar 

  16. Fisher B, Redmond C, Fisher ER: the contribution of recent NSABP clinical trails of primary breast cancer therapy to an understanding of tumor biology - an overview of findings. Cancer 46(4 Suppl): 1009–1025, 1980

    Google Scholar 

  17. Dowlatshahi K, Fan M, Snider HC, Habib FA: Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer 80(7): 1188–1197, 1997

    Google Scholar 

  18. Lam WW, Yang WT, Chan YL, Stewart IE, Metreweli C, King W: Detection of axillary lymph node metastases in breast carcinoma by technetium - 99m sestamibi breast scintigraphy, ultrasound and conventional mammography. European J Nucl Med 23(5): 498–503, 1996

    Google Scholar 

  19. Folkman J: What is the evidence that tumors are angiogenesis dependent?. J Natl Cancer Inst 82(1): 4–6, 1990

    Google Scholar 

  20. Folkman J: Angiogenesis in cancer, vascular, rheumatoid and other disease. Nature Med 1: 27–31, 1995

    Google Scholar 

  21. Horak ER, Leek R, Klenk N, LeJeune S, Smith K, Stuart N, Greenall M, Stepniewska K, Harris AL: Angiogenesis, assessed by platelet/endothelial cell adhesion molecule antibodies, as indicator of node metastases and survival in breast cancer. Lancet 340(8828): 1120–1124, 1992

    Google Scholar 

  22. Feldman F, Habif D, Fleming R, Kanter I, Seaman W: Arteriography of the breast. Radiology 89: 1053–1061, 1967

    Google Scholar 

  23. Haga S, Watanabe O, Shimizu T, Imamura H, Kobayashi K, Kinoshita J, Nagumo H, Kajiwara T: Analysis of hte tumor staining obtained by preoperative IV-DSA for breast cancer patients: density and metastasis correlation. Breast Cancer Res Treat 43(2): 129–135, 1997

    Google Scholar 

  24. Furman-Haran E, Margalit R, Grobgeld D, Degani H: Dynamic contrast-enhanced magnetic resonance imaging reveals stress-induced angiogenesis in MCF7 human breast tumors. Proc Natl Acad Sci USA 93: 6247–6251, 1996

    Google Scholar 

  25. Liotta LA., Steeg PS, Stetler-Stevenson GS: Cancer metastasis and angiogenesis: An imbalance of positive and negative regulation. Cell 64: 327–336, 1991

    Google Scholar 

  26. Herman PG, Kim C, de Sousa MAB, Mellins HZ: Microcirculation of the lymph node with metastasis. Am J Pathol 85: 333–348, 1976

    Google Scholar 

  27. Wu CH, Hsu MM, Chang YL, Hsieh FJ: Vascular pathology of malignant cervical lymphadenopathy: qualitative and quantitative assessment with power Doppler ultrasound. Cancer 83(6): 1189–1196, 1998

    Google Scholar 

  28. Parums DV, Cordell JL, Micklem K, Heryet AR, Gatter KC, Mason DY: JC70: a new monoclonal antibody that detects vascular endothelium associated on routinely processed tissue sections. J Clin Pathol 43: 752–757, 1990

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shimizu, T., Hino, K., Tauchi, K. et al. Predication of axillary lymph node metastasis by intravenous digital subtraction angiography in breast cancer, its correlation with microvascular density. Breast Cancer Res Treat 61, 261–269 (2000). https://doi.org/10.1023/A:1006449619475

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006449619475

Navigation