Color-coded and spectral Doppler flow in breast carcinomas--relationship with the tumor microvasculature.

The phenomenon of tumor angiogenesis is an important aspect of understanding tumor biology. Studies in breast carcinoma have shown microvessel density (MVD) assessed by immunohistochemistry to be of prognostic importance in primary breast cancer. On the other hand, recently developed highly sensitive color-coded Doppler techniques offer a noninvasive method to examine neovascularisation in breast tumors. The purpose of this study was to determine the relationship between Doppler flow parameters and microvessel count assessed by immunohistochemistry. Fifty-three patients with primary breast cancer were examined preoperatively with color-coded Doppler ultrasound. The obtained Doppler frequency spectra were analyzed for peak systolic flow velocity (Vmax). Following surgery, paraffin-embedded microsections were immunohistochemically stained for factor VIII-related antigen. Tumor angiogenesis was assessed by microvessel count under light microscopy. Undifferentiated tumors correlated with high MVD (p=0.009) whereas other clinicopathological parameters were not associated with MVD. Color Doppler signals were detected in 50 out of 53 breast tumors. Evaluation of tumor flow velocity with various clinicopathological parameters showed a significant correlation with tumor size (p=0.0001) and lymph node metastasis (p=0.02). However, there was no significant correlation between MVD and intratumoral blood flow velocity assessed by color-coded Doppler. Our findings showed that Doppler flow measurement did not correlate with the extent of tumor angiogenesis of breast cancer. The present data give circumstantial evidence that microvessel count assessed by immunohistochemistry reflects the microvascular network, whereas tumor vasculature documented by Doppler ultrasound supplies information on the macrovasculature.

Endometrial cancer after tamoxifen treatment: a descriptive study of 25 breast cancer patients who subsequently developed endometrial cancer.

The aim of this study was to determine whether tamoxifen affects the histopathological features and clinical outcome of endometrial cancer occurring after breast cancer. 25 patients with a history of breast cancer who subsequently developed endometrial cancer were identified by computer assisted linkage of the Lainz Medical Center Tumor Registry with the National Austrian Cancer Registry. 8 endometrial cancers were tamoxifen-associated, whereas 17 cases were not. The median time of tamoxifen use was 32 months, with a median cumulative tamoxifen dose of 27 g. Detailed histopathological data did not show substantial difference between the two groups. The distribution by stage (FIGO) in the tamoxifen group was Stage I, 7 (87.5) with 1 patient unstaged (12.5%); and Stage I, 13 (76%), II, 2 (12%) and, stage III 2 (12%) for the non-tamoxifen users. No risk of high-grade endometrial lesions with a poor prognosis was found. The only suggestion of a difference was a trend for the mean interval between detection of breast and endometrial cancer to be shorter in the tamoxifen group (50.5 vs. 88.1 months p = 0.07). The conclusion to be drawn from this study appears to be that endometrial cancers occurring after tamoxifen exposure are of the same tumor type. Due to the small number of cases described we were not able to disprove the hypothesis that tamoxifen associated tumors were different in terms of clinical outcome and survival. Regular gynecological examinations are recommended for all breast cancer patients.