(686.19) Does VEGF Expression Correlate with Lymphatic Metastasis in Breast Cancer?

Poster Board Number: D19

Ashita Rukmini (Maharishi Markandeshwar Institute od Medical Sciences and Research), Sandeep Mathur (All India Institue of Medical Sciences), Seenu Vuthaluru (All India Institue of Medical Sciences)

Introduction: Primary tumor characteristics are increasingly used for prognostication, predicting lymph node metastasis and planning adjuvant treatment in breast cancer. Vascular Endothelial Growth factor (VEGF) has been postulated to stimulate lymph vessels development and growth in tumors. Few studies on cell lines have documented how the new lymphatics develop or tumor cells invade these lymphatics. However, in human breast cancer the literature is sparse. Hence, this study is done to see the expression of VEGF and its correlation with lymphatic invasion in breast cancer patients.

Materials amp;

Methods: Formalin fixed paraffin embedded blocks of breast cancer specimens and controls were retrieved amp; 4u thick sections stained with Hamp;E stains for morphological evaluation. Serial sections were cut on APES (3-Triethoxysilylpropylamine) coated slides for performing immunohistochemistry using monoclonal antibodies against VEGF and DII40. The expression intensity of VEGF and its distribution in the tumor samples were observed and semi-quantitatively analyzed. VEGF expression was interpreted as follows: negative (0): lt;5% staining; weak (+): 5–25% staining; positive (++): 26–50% staining; strongly positive (+++): gt;50% staining. Statistical analysis: samples with 0/+ staining were considered in low VEGF expression, while samples with ++/+++ expression were considered as high VEGF expression. For DII40 well demarcated vessels showing positivity in endothelial cells were counted per 10hpf after selecting hot spots at scanner view. For statistical analysis, 0 was considered as no expression and 1/10HPF was considered as high expression. Association between levels of VEGF and D II 40 was examined by the two-way scatter plot and a linear regression analysis of DII 40 over VEGF. The association of positivity between the two markers was assessed using Chi Square test.

Results: High VEGF expression was seen 33 of the 43 evaluable patients (76.74%%; 95% CI 61.37%-88.24%) and high DII 40 expression was seen in 30 of the 44 patients (68.18%; 95% CI 52.42%-81.39%). Of the 33 patients with high VEGF expression, DII 40 was expressed in 26 of them (78.79%). There was a strong association between VEGF expression and DII 40 expression (plt;0.01) (Figure 1). The variance explained by VEGF level in the variance of DII 40 as measured by the correlation (R2) was 0.1265 (p=0.02). When the expression of VEGF and D II 40 was compared with tumor characteristics, there was statistically significant correlation with lymphovascular invasion (LVI) but not with tumor size, type, grade, ER/PR status, Her2neu status or lymph node involvement.

Conclusion: VEGF expression is high in most tumors. There is significant association between LVI amp; lymph vessels detection as studied by D II 40 expression and VEGF expression. Further studies in clinical settings are essential before incorporating VEGF expression for prognostication and customized patient care.



Figure1: Scatter diagram of VEGF and DII 40 expression in primary tumor