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Evaluation of Tumor Angiogenesis of Breast Carcinoma Using Contrast-Enhanced Digital Mammography

Clarisse Dromain1, Corrine Balleyguier1, Serge Muller2, Marie-Christine Mathieu3, France Rochard4, Paule Opolon3 and Robert Sigal1

1 Department of Radiology, Institut Gustave Roussy, 39 rue Camille Desmoulin, Villejuif Cedex, France 94805.
2 GE Healthcare, Buc, France.
3 Department of Pathology, Institut Gustave Roussy, Villejuif Cedex, France.
4 Department of Surgery, Institut Gustave Roussy, Villejuif Cedex, France.


Figure 1
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  		Fig. 1 —Kinetic curves of contrast enhancement. Type 1 = early enhancement followed by washout, type 2 = early enhancement followed by plateau, type 3 = gradually increasing enhancement, type 4 = decrease of enhancement with time.

 

Figure 2
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  		Fig. 2A —62-year-old woman with nonpalpable mass at physical examination. Craniocaudal mammogram shows two opacities in upper outer quadrant (arrows).

 

Figure 3
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  		Fig. 2B —62-year-old woman with nonpalpable mass at physical examination. Subtraction image derived from 1.30-second contrast-enhanced digital mammography image shows two adjacent areas of enhancement, one with strong and spiculated enhancement (arrow) and one with moderate and less-circumscribed enhancement (arrowheads).

 

Figure 4
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  		Fig. 2C —62-year-old woman with nonpalpable mass at physical examination. Kinetic curves of enhancement derived from regions of interest drawn in strong area of enhancement (•) shows early enhancement followed by washout, whereas moderate area of enhancement ({blacksquare}) shows gradually increasing enhancement.

 

Figure 5
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  		Fig. 2D —62-year-old woman with nonpalpable mass at physical examination. At histopathologic examination, lesion with strong and early contrast enhancement proved to be ductal carcinoma in situ, whereas lesion with gradually increasing enhancement proved to be invasive ductal carcinoma.

 

Figure 6
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  		Fig. 2E —62-year-old woman with nonpalpable mass at physical examination. Immunohistochemically stained section (anti-CD34 stain) shows intratumoral microvessel density values higher for in situ (167.04 microvessels/mm2) than for invasive (69.03 microvessels/mm2) component of tumor.

 

Figure 7
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  		Fig. 3A —43-year-old woman with palpable mass at physical examination. Craniocaudal mammogram shows no obvious abnormality.

 

Figure 8
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  		Fig. 3B —43-year-old woman with palpable mass at physical examination. Subtraction image derived from 1.30-second contrast-enhanced digital mammography image well depicts round enhancing mass in deep part of breast (arrow).

 

Figure 9
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  		Fig. 3C —43-year-old woman with palpable mass at physical examination. Kinetic curve of contrast enhancement derived from regions of interest drawn in this lesion shows early enhancement followed by plateau.

 

Figure 10
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  		Fig. 3D —43-year-old woman with palpable mass at physical examination. Histologic section with standard staining (H and E) revealed invasive ductal carcinoma.

 

Figure 11
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  		Fig. 3E —43-year-old woman with palpable mass at physical examination. Immunohistochemically stained section (anti-CD34 stain) shows numerous microvessels (brown markings) in tumor stroma with intratumoral microvessel density value of 104.33/mm2.

 

Figure 12
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  		Fig. 4A —45-year-old woman with palpable mass at physical examination. Craniocaudal mammogram shows well-circumscribed opacity (arrow).

 

Figure 13
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  		Fig. 4B —45-year-old woman with palpable mass at physical examination. Subtraction image derived from 1.30-second contrast-enhanced digital mammography image shows homogeneous enhancement of lesion (arrow).

 

Figure 14
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  		Fig. 4C —45-year-old woman with palpable mass at physical examination. Kinetic curve of contrast enhancement derived from regions of interest drawn in this lesion shows gradually increasing enhancement.

 

Figure 15
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  		Fig. 4D —45-year-old woman with palpable mass at physical examination. Histologic section with standard staining (H and E) reveals invasive ductal carcinoma.

 

Figure 16
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  		Fig. 4E —45-year-old woman with palpable mass at physical examination. Immunohistochemically stained section (anti-CD34 stain) shows high density of microvessels (brown markings) in tumor with intratumoral microvessel density value of 103.78 microvessels/mm2.

 

Figure 17
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  		Fig. 5A —60-year-old woman with palpable nodule at physical examination. Craniocaudal mammogram shows opacity (arrow).

 

Figure 18
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  		Fig. 5B —60-year-old woman with palpable nodule at physical examination. Subtraction image derived from 1.30-second contrast-enhanced digital mammography image shows "black lesion" (arrow).

 

Figure 19
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  		Fig. 5C —60-year-old woman with palpable nodule at physical examination. Kinetic curve of contrast enhancement derived from regions of interest drawn in this lesion shows unexpected decrease of enhancement with time, probably caused by motion artifacts.

 

Figure 20
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  		Fig. 5D —60-year-old woman with palpable nodule at physical examination. Histologic section with standard staining (H and E) reveals invasive ductal carcinoma.

 

Figure 21
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  		Fig. 5E —60-year-old woman with palpable nodule at physical examination. Immunohistochemically stained section (anti-CD34 stain) shows high density of microvessels (brown markings) in tumor with intratumoral microvessel density value of 85.61/mm2.

 

Figure 22
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  		Fig. 6 —Correlation between size at histology and size measured on contrast-enhanced digital mammography image.

 

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