Prognostic significance of image morphometric microvessel enumeration in breast carcinoma

Using image morphometry, microvessel density was analyzed in 58 stage-heterogeneous breast carcinomas by counting vascular cross-sections in type IV collagen (basal lamina)-immunostained cryostat sections (methanol fixed, avidin-biotin method). Vascular density (mean, 19 vessels per square millimeter) did not correlate with metastatic disease at presentation (localized: 17.6 vessels per square millimeter vs. node/distant metastases: 20 vessels per square millimeter, P = NS). Short-term disease-free survival, however, was significantly related to intratumoral vascularity overall (no recurrence: mean = 14 vessels per square millimeter vs. recurred: mean = 26 vessels per square millimeter, P = .001) and in node-negative patients (no recurrence: mean = 12.1 vessels per square millimeter vs. recurred: mean = 27.8 vessels per square millimeter, P = .005; mean follow-up, 52 months). Further, 87% (7/8) of patients with microvascular counts greater than 30 vessels per square millimeter had recurrence vs. only 15% (2/13) with counts less than 10 vessels per square millimeter. We conclude that image morphometric quantitation of vascular basal lamina represents an objective means of assessing angiogenic capacity in breast tumors, which correlates strongly with disease aggressiveness in short-term follow-up.