Correlation of microvessel parameters in invasive ductal carcinoma of the breast and fibroadenomas: a morphometric study

Evaluation of Number Density of Tumor-Associated Macrophages by Immunohistochemistry and Semiquantitative Scoring in Invasive Breast Cancer: An Indian Study

Context

Tumor microenvironment is emerging as a critical factor for progression of breast cancer. Tumor-associated macrophages (TAMs) play an important role in promoting tumor growth.

Aim

This study was aimed at correlation of number density (ND) of TAMs with invasive ductal carcinoma (IDC) grading utilizing an image morphometric technique. We also sought to compare the TAMs and ND in the tumoral area and stromal region. We also explored the relationship between the clinical and pathological prognostic parameters.

Subjects and Methods

The study included 75 cases of IDC that had undergone modified radical mastectomy. The Institutional Ethics Committee approved the study. Samples were classified as Grade 1, 2, and 3. Cases were graded as per the modified Bloom and Richardson criterion. Mean with standard deviation was calculated for each group. We utilized CD68 and CD163 immunostained sections for determining the ND of TAMs. TAMs were evaluated using computerized digital photomicrograph system with image analyzing software. ND was defined as the number of TAMs in total number of TAMs in five high-power fields/total area of five fields. ND was calculated separately in tumor and tumor stroma (TS). Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2/neu (HER2/neu) were scored in accordance with recommendations. Ki-67 was scored as per the recommended guidelines.

Statistical Analysis Used

Data were tabulated in Microsoft Excel. SPSS version 20.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. To determine the relationship between macrophage density and clinicopathologic parameters, we used the independent t-test. To determine the differences in the parameters, analysis of variance (ANOVA) was utilized.

Results

Age of the patients ranged from 34 to 58 years (mean: 55.5). One-way ANOVA between various grades of tumor indicating significant differences in terms of CD68 and CD163 densities in tumor and stroma (P < 0.0001). i.e., significant increased density of CD68 and CD163 was observed in Grade 3 tumor as compared to other two groups. A greater histological grade, ER, PR negative status, and a high Ki-67 index were all associated with TAM ND. There was no relation to HER2/neu status. Result of unpaired t-test indicates increased density in stroma as compared to tumor among various grades of IDC.

Conclusions

We analyzed images with a software using photographs of the stained slides. This helped in quantitative analysis of TAMs on the CD68 and CD163 stained sections. This approach standardizes and reproducibly counts TAMs per unit area. We found significant difference between the number densities of TAMs in grades of invasive breast carcinoma. There were statistically significant differences in numerical densities of TAMs with ER, PR negativity, and Ki-67. There was no correlation with HER2/neu. Densities of CD68 and CD163 densities are more prevalent in TS as compared to intratumoral region.

Effect of energy requirements in the growth of brain tumor: a theoretical approach

A malignant tumor is an uncontrolled growth of tissues receiving energy in form of the nutrients provided by the microvascular networks. It is proposed that the supplied energy to a tumor is used for three purposes: the creation of new cells, maintenance of tumor cells, and tumor volume expansion by overcoming external pressure. A mathematical model studying the effects of energy required for maintenance and overcoming external pressure, the energy required creating a single cell, death rate, and tumor cell density on tumor development has been formulated. Including a term, residual energy for tumor growth in the tumor growth equation, the well-known logistic equation has been re-derived for tumors. Analytical solutions have been developed, and numerical analysis for the growth in brain tumors with the variation of parameters related to energy supply, the energy required for maintenance, and expansion of tumor has been performed. Expressions for the tumor growth rate(r) and carrying capacity(C) of the tumor are formulated in terms of the parameters used in the model. The range of 'r', estimated using our model is found within the ranges of tumor growth rates in gliomas reported by the other researchers. Selecting the model parameters precisely for a particular individual, the tumor growth rate and carrying capacity could be estimated accurately. Our study indicates that the actual growth rate and carrying capacity of a tumor reduce and tumor saturation time increases with the increase of death rate, the energy required for a single cell division, and energy requirement for the tumor cell maintenance.

Cisplatin effect on digital cytomorphometric and bioinformatic tumor cell characteristics in rat ovarian cancer model-a preliminary study

BACKGROUND

Ovarian cancer is one of the most common diseases of the female reproductive system. The aim of this study was the investigation of the antitumor cisplatin effect on ascitic fluid tumor cells in the ovarian cancer experimental model by digital cytomorphometry and cell bioinformatic analysis.

METHODS

Female Wistar rats were inoculated by ovarian cancer strain. After ovarian cancer transplantation rats were divided into two groups: control group-without cisplatin treatment, the experimental group-under cisplatin treatment. The ascitic fluid was taken on the 9-th day after tumor cell inoculation. Digital cytomorphometric and cytobioinformatic analysis were used to study ascitic fluid cancer cell morphofunctional changes under cisplatin treatment.

RESULTS

Digital cytomorphometric characteristics of rat ovarian cancer ascitic cells were obtained. Tumor cells were classified into four groups according to their geometric size: small, medium, large, "gigantic". The algorithm and the computer program based on tumor cell morphometric characteristics were created to calculate such cell bioinformatic characteristic as information redundancy coefficient R. Three parameters were determined as the criteria of cisplatin effect on cancer cells: cell number, nuclear/cytoplasmic ratio, R-value.

CONCLUSIONS

Data obtained suggest that cisplatin reduces the total cell number, the nuclear/cytoplasmic ratio and R-value thus indicates a decrease in cellular resistance and adaptive potential. The digital cytomorphometry and bioinformatics could be recommended as a testing system in the experimental or clinical study.

Correlation study between flash dual source CT perfusion imaging and regional lymph node metastasis of non-small cell lung cancer

Background

To explore the correlation of flash dual source computed tomography perfusion imaging (CTPI) and regional lymph node metastasis of non-small cell lung cancer (NSCLC), and to evaluate the value of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC.

Methods

120 consecutive patients with NSCLC confirmed by postoperative histopathology were underwent flash dual source CT perfusion imaging in pre-operation. The CT perfusion parameters of NSCLC, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability (PMB) were obtained by the image post-processing. Then microvessel density (MVD), luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP) of NSCLC were counted by immunohistochemistry. These cases were divided into group A (patients with lymph node metastasis, 58 cases) and group B (patients without lymph node metastasis, 62 cases) according to their pathological results. The CT perfusion parameters and the microvessel parameters were contrastively analysed between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC in pre-operation.

Results

Group A presented significantly lower LVA, BF and higher MTT, PMB than Group B (P < 0.05), while BV, LVN, LVP and MVD were no significant difference (P > 0.05). Correlation analysis showed that BF was correlated with LVA and LVP (P < 0.05), while BV, MTT and PMB were not correlated with LVN, LVA and LVP (P > 0.05). All the perfusion parameters were not correlated with MVD. According to the ROC curve analysis, when BF < 85.16 ml/100 ml/min as a cutoff point to predict regional lymph node metastasis of NSCLC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 60.8, 81.7, 71.5, 75.6 and 69.5% respectively.

Conclusion

Flash dual source CT perfusion imaging can non-invasively indicate the luminal vascular structure of tumor and BF can be used as one of the important indexes in predicting regional lymph node metastasis of NSCLC in pre-operation.

Correlation study between dual source CT perfusion imaging and the microvascular composition of solitary pulmonary nodules

OBJECTIVE

To explore the correlation between dual source computed tomography perfusion imaging (CTPI) and microvascular parameters, and evaluate the value of CTPI in the differential diagnosis of solitary pulmonary nodule (SPN).

METHODS

65 consecutive patients with SPN who successfully underwent pre-operative CT perfusion imaging with dual source CT and received a final diagnosis by postoperative pathology. The cases were divided into malignant, benign and inflammatory groups according to the pathological results. CT perfusion parameters, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface (PMB) were obtained by performing CTPI of SPNs. The postoperative specimens of SPNs were immunohistochemically stained for CD34 and SMA to detect microvessel density (MVD) and luminal vascular parameters, such as luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP). The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameter in diagnosing malignant SPNs.

RESULTS

In these 65 cases, malignant, benign and inflammatory SPNs were respectively 39, 14 and 12 cases. Significant difference was observed in LVN/MVD, LVA and LVP among the three groups (P < 0.05). The correlation between CT perfusion parameters (BF, BV and PMB) and the luminal vascular parameters was stronger than that with MVD (P < 0.05). PMB has the strongest correlation with LVN/MVD. Using BF≥60ml/100ml/min, BV≥6.34ml/100ml and PMB≥13.35ml/100 ml/min for the diagnosis, the area under the curve (AUC) of the ROC curve was 0.760, the sensitivity was 82% and the specificity was 61%.

CONCLUSIONS

The main indicators reflecting blood perfusion of SPN are the degree of lumen or maturity of microvessels (LVN, LVA and LVP), not just the number of microvessels (e.g. MVD). CT perfusion imaging can be used as an important method to non-invasively evaluate tumour angiogenesis and help to distinguish malignant SPNs from benign and inflammatory SPNs.

A pilot study of low-dose CT perfusion imaging (LDCTPI) technology in patients with triple-negative breast cancer

PURPOSE

To investigate associations between the clinicopathologic features and CT perfusion parameters of triple-negative breast cancer (TNBC) and non-TNBC using low-dose computed tomography perfusion imaging (LDCTPI), and to find potential clinical applications in the prognosis assessment of TNBC.

MATERIALS AND METHODS

A total of 60 patients with breast cancer confirmed by pathological examination were studied prospectively using LDCTPI on a 64-slice spiral CT scanner. The acquired volume data were used for calculations, mapping, and analysis by using a tumor perfusion protocol in the CT perfusion software package to measure 2 parameters namely, blood flow (BF), and permeability surface (PS) area product. Patients were grouped into TNBC (n = 27) and non-TNBC (n = 33) subtypes. Associations between these two subtypes and clinicopathologic characteristics were evaluated by both univariate and multivariate logistic regression. CT perfusion parameters values were compared for clinicopathologic characteristics using independent 2-sample t test.

RESULTS

TNBC displayed higher CT perfusion parameters values (BF: 57.56±10.94 vs 52.70±7.79 mL/100 g/min, p = 0.006; PS: 38.98±9.46 vs 33.39±8.07 mL/100 g/min, p = 0.001) than non-TNBC. In addition, breast cancer with poorly histologic grade or positive Ki-67 expression showed higher BF and PS values than those with well and moderately histologic grade or negative Ki-67 expression (p < 0.05). TNBC had poorer histologic grade (P = 0.032) and higher Ki-67 expression (P = 0.013) than non-TNBC.

CONCLUSION

LDCTPI is a functional imaging technology from the perspective of hemodynamics with potential of clinical applications. The BF and PS values were higher in TNBC patient group than non-TNBC group. TNBC patients also have poorer clinicopathologic outcome.

New Doppler imaging technique for assessing angiogenesis in breast tumors: correlation with immunohistochemically analyzed microvessels density

BACKGROUND

Microvessel density (MVD) is associated with grade and prognosis in breast tumors. However, conventional color Doppler flow (CDF) imaging has been limited to represent MVD of breast tumors.

PURPOSE

To evaluate whether a new Doppler imaging technique (AngioPLUS) can represent MVD of breast tumors.

MATERIAL AND METHODS

The institutional review board approved this retrospective study, and patients' informed consent was waived. CDF and AngioPLUS were available in pathologically confirmed 55 breast tumors of 53 women. For each lesion, vascular flow patterns (distribution and amount) of both Doppler images were retrospectively reviewed, and MVD was measured using immunohistochemical analysis of the biopsied tissue sections. MVD was subcategorized as low or high group with reference to the median. The associations between the Doppler features and MVD were evaluated using Fisher's exact test and Student's t test.

RESULTS

Of the 55 masses, 28 (50.9%) were benign and 27 (49.1%) were malignant. Vascular flow distribution and amount of both Doppler imaging were different between the benign and malignant lesions (CDF, P = 0.020 and P = 0.010; AngioPLUS, P = 0.002 and P = 0.005). MVD had no significant relationships with CDF features, but vascular flow distribution on AngioPLUS showed significant differences between the lesions with low and high MVD ( P = 0.020); Combined distribution was more frequent in the high MVD lesions than in the low MVD lesions (17/28, 60.7% vs. 6/27, 22.2%).

CONCLUSION

Our data confirmed the correlation between a new Doppler imaging technique, AngioPLUS, and MVD. We suggest that AngioPLUS can be used for assessing MVD in breast tumors.

Comparison of the Diagnostic Performance of Power Doppler Ultrasound and a New Microvascular Doppler Ultrasound Technique (AngioPLUS) for Differentiating Benign and Malignant Breast Masses

This study was performed to compare the diagnostic performance of power Doppler ultrasound (US) and a new microvascular Doppler US technique (AngioPLUS; SuperSonic Imagine, Aix-en-Provence, France) for differentiating benign and malignant breast masses. Power Doppler US and AngioPLUS findings were available in 124 breast masses with confirmed pathologic results (benign, 80 [64.5%]; malignant, 44 [35.5%]). The diagnostic performance of each tool was calculated to distinguish benign from malignant masses using a receiver operating characteristic curve analysis and compared. The area under the curve showed that AngioPLUS was superior to power Doppler US in differentiating benign from malignant breast masses, but the difference was not statistically significant.

A clinical application of dynamic contrast-enhanced CT (DCE-CT) in patients with variously differentiated breast ductal carcinoma

PURPOSE

To explore the hemodynamic characteristics of variously differentiated breast ductal carcinoma (BDC) using the dynamic contrast-enhanced CT (DCE-CT) based CT perfusion imaging (CTPI), including the specific perfusion parameter values, and to identify potential clinical applications in the cell differentiation degree of BDC.

MATERIALS AND METHODS

Forty patients with breast ductal carcinoma confirmed by needle puncture biopsy were studied prospectively using CTPI on a 64-slice spiral CT scanner. The acquired volume data were used for calculations, mapping, and analysis by using a tumor perfusion protocol in the CT perfusion software package to measure 4 parameters namely, blood flow (BF), blood volume (BV), mean transit time (MTT), and the permeability surface (PS) area product. The different differentiated BDC with CT perfusion parameters were divided into 3 groups of high, moderate and poor differentiation. The comparison among these groups were then made using statistical data analysis software.

RESULTS

The patients were categorized into three groups of 12, 13, and 15 highly, moderately and poorly differentiated ductal carcinoma cases, respectively. Comparing the perfusion parameters values of the three groups, BF, BV, and PS values increased from highly to poorly differentiated BDC cases. Differences between the highly and moderately or poorly differentiated groups were all statistically significant for BF, BV, and PS values (p < 0.05), while MTT value showed no statistical difference among the three groups (p > 0.05).

CONCLUSION

CTPI is a functional imaging technology from the perspective of hemodynamics with potential clinical applications. Three parameters of BF, BV and PS values have potential to serve as indicators of the cell differentiation degree of the breast ductal carcinoma.

An application study of low-dose computed tomography perfusion imaging (LDCTPI) in breast cancer and breast fibroadenoma

PURPOSE

To explore the characteristics of breast cancer and breast fibroadenoma using low-dose computed tomography perfusion imaging (LDCTPI) including specific perfusion parameter values, and seek the potential clinical applications in cancer prognosis assessment.

MATERIALS AND METHODS

Fifty patients including 30 diagnosed with breast cancer and 20 with breast fibroadenoma, as well as 15 control subjects with normal breasts were studied prospectively using LDCTPI examinations. The acquired volumetric imaging data were used for calculation, mapping and analysis by using a body tumor perfusion protocol in the CT perfusion software to measure 4 parameters: blood flow (BF), blood volume (BV), mean transit time (MTT), and the permeability surface (PS) area product. Statistical data analysis was then performed to distinguish the difference of the 4 parameter values among normal control, breast cancer and breast fibroadenoma cases.

RESULTS

The mean perfusion values of 15 normal controls were as follows: BF, 20.03±4.08 mL/100 g/min; BV, 4.53±0.95 mL/100 g; MTT, 5.90±0.82 s; and PS, 9.25±1.18 mL/100 g/min. The mean perfusion values of 30 cancer patients were as follows: BF, 56.67±6.59 mL/100 g/min; BV, 5.82±0.68 mL/100 g; MTT, 6.01±0.82 s; and PS, 24.95±5.05 mL/100 g/min. The mean perfusion values of 20 patients with breast fibroadenoma were as follows: BF, 46.24±6.65 mL/100 g/min; BV, 5.07±0.73 mL/100 g; MTT, 7.51±0.62 s; and PS, 16.73±6.48 mL/100 g/min. Comparing the 3 groups, differences were all statistically significant for BF, BV, MTT and PS values (p < 0.05, respectively); The BF, BV, PS values were highest in group of cancer patients, while the MTT value was highest in group of patients diagnosed with breast fibroadenoma.

CONCLUSION

Breast CT perfusion imaging is a promising functional imaging technology in breast cancer diagnosis, which can provide valuable quantitative imaging markers to assist evaluation of breast tumors.