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.