Marialuisa Di Matteo, Presenter: Nothing to Disclose

Paolo Belli MD, Abstract Co-Author: Nothing to Disclose

Giovanni Giuseppe Giardina MD, Abstract Co-Author: Nothing to Disclose

Federico Padovano, Abstract Co-Author: Nothing to Disclose

Enida Bufi, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

The purpose of the present investigation was twofold. First, we aimed to determine the association of asymmetric increase in breast vascularity (AIBV) with clinical/pathologic and molecular profiles of breast cancer. Second, we addressed the prognostic performance of AIBV and of vascular maps reduction after Neoadjuvant Chemotherapy (NAC) in predicting the complete pathological response (pCR) to NAC. 

Two hundred and nineteen patients with unilateral locally advanced breast cancer (LABC) that underwent magnetic resonance imaging (MRI) before and after NAC were retrospectively enrolled. MRI included morphological assessment and DWI with apparent diffusion coefficient (ADC). Axial, sagittal and coronal maximum intensity projection images were obtained to allow a subjective comparative evaluation based on a combination of vessels numbers, diameter and signal intensity to define asymmetrical or symmetrical breasts vascularity. The pCR was assessed (Mandard classification). 

In 62,5% cases, there was an AIBV ipsilateral to the LABC (p<0.001). High histologic grade (p<0.001), invasive ductal carcinoma (p=0.05), Triple Negative, HER2+, and Hybrid phenotypes (p=0.02) were significantly associated with AIBV. pCR to NAC was more frequent among the LABC with ipsilateral AIBV (24%) than those with symmetrical breast vascularity (6%) (p= 0.001). After NAC, vascular map in the breast with LABC was significantly reduced, particularly in patients with pCR (p< 0.001). The breast vascular maps reduction after NAC displayed a superior diagnostic performance in the prediction of the pCR [area under the receiver operating characteristic curve (AUC)=0.715] vs AIBV before NAC (AUC=0.647); especially if ADC value raise after NAC is implemented as a concurrent diagnostic criterion (AUC=0.753).  

LABC with ipsilateral AIBV is associated with more aggressive clinical/pathologic and molecular profiles. Nonetheless, is more sensitive to NAC and shows a higher frequency of pCR. 

The assessment of breast vascular maps may represent an additional tool in LABC treatment planning and in predicting tumor response to NAC, without acquisition time or cost increment.

Di Matteo, M, Belli, P, Giardina, G, Padovano, F, Bufi, E, Bonomo, L, The Hypervascularity Paradox: Association between Asymmetric Increase in Breast Vascularity and Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13022779.html