SAN ANTONIO--Mammographic signs of angiogenesis and neovascularity
may identify a developing breast cancer years before the lesion
becomes visible, Parvis Gamagami, MD, said at the San Antonio
Breast Cancer symposium.
At The Breast Center, Van Nuys, Calif, a review of xeromammograms
of 204 breast cancer patients, made up to 13 years before cancer
detection, showed that vascular evidence of tumor development
preceded the mammographic appearance of 91% of nonpalpable lesions
and 100% of advanced palpable lesions.
Signs of tumor-related angiogenesis include hypervascularity,
vessel dilation or engorgement, focally convergent vessels, and
especially calcification of the nutrient artery of the carcinoma
(for unknown reason). "If a single calcified vessel appears
in only one breast without evidence of malignancy, that is a strong
indication of high risk," said Dr. Gamagami, a radiologist
at the Van Nuys Breast Center.
He believe that mammographic evidence of angiogenesis can be used
to identify very small, early-stage lesions that otherwise could
be missed. In their study, they identified vessel convergence
in malignancies as small as 5 mm.
Evidence of tumor angiogenesis is often dismissed as benign vascularity
or nonpathologic asymmetry, Dr. Gama-gami said. In some instances,
the signs are simply overlooked.
Patients with evidence of breast cancer angiogenesis should be
followed closely, probably with annual mammograms, at least in
the affected breast, Dr. Gamagami advised. "We know that
a preneoplastic condition exists years before malignant transformation
occurs," he said. "We don't have any criteria to help
us decide which breast or breasts will develop cancer. Angiogenesis
may be helpful in that respect, so when we see a single calcified
artery, we have to follow its itinerary to see where it ends."
Investigators at Van Nuys have begun evaluating the use of core
biopsy in women who have suspicious vessels that end in areas
of parenchymal hyperdensity, one characteristic of malignancy.