This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (21)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Oncology  • Breast Cancer  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

S. David Nathanson, MD; Richard J. Zarbo, MD; D. Lynne Wachna, BSN; Caryle A. Spence; Tanja A. Andrzejewski; Judith Abrams, PhD

Arch Surg. 2000;135:586-594.

Hypothesis  The density of vasoactive endothelial growth factor receptor 3–immunostained microvessels in primary breast cancers correlates with the incidence of axillary lymph node metastasis.

Design  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 x200. Axillary lymph nodes were evaluated for metastases by light microscopy.

Setting  A multidisciplinary breast cancer clinic and laboratory.

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

Main Outcome Measures  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.

Conclusion  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; ²=53.4; P<.001; area under the receiver operation characteristic curve=0.97).

From the Departments of Surgery (Dr Nathanson and Mss Wachna, Spence, and Andrzejewski), Pathology (Dr Zarbo), and Biostatistics (Dr Abrams), Henry Ford Health System, Detroit, Mich.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2000;135(5):609-610.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A Novel Gene Expression Profile in Lymphatics Associated with Tumor Growth and Nodal Metastasis
Clasper et al.
Cancer Res. 2008;68:7293-7303.
ABSTRACT | FULL TEXT  

Correspondence re: S. Maula et al., Intratumoral Lymphatics Are Essential for the Metastatic Spread and Prognosis in Squamous Cell Carcinoma of the Head and Neck. Cancer Res., 63: 1920-1926, 2003.
Padera et al.
Cancer Res. 2003;63:8555-8557.
FULL TEXT  

Prevention and Treatment of Lymphatic Metastasis by Antilymphangiogenic Therapy
Jain and Padera
JNCI J Natl Cancer Inst 2002;94:785-787.
FULL TEXT