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Necrosis Degree Displayed in Computed Tomography Images Correlated With Hypoxia and Angiogenesis in Breast Cancer

Shan, Xiuhong MS; Wang, Dehang MS; Chen, Jianhua MS; Xiao, Xiudi BS; Jiang, Yanni PhD; Wang, Yafei BS; Fan, Yu PhD

Journal of Computer Assisted Tomography: January/February 2013 - Volume 37 - Issue 1 - p 22–28
doi: 10.1097/RCT.0b013e318279abd1
Thoracic Imaging

Objective The objective of this study was to investigate the correlation between the degree of necrosis displayed in computed tomography (CT) image and the expression of hypoxic and angiogenesis biomarkers of breast cancer.

Methods Forty-four breast cancer cases were examined with CT before surgery. Tumor specimen expressions of glucose transporter 1 (Glut1), hypoxia-inducible factor 1α (HIF-1α), carbonic anhydrase IX (CA IX), vascular endothelial growth factor (VEGF), and CD34 (as a marker of vascular endothelial cells) were detected by immunohistochemistry.

Results The expressions of Glut1 and CA IX were localized primarily to the edges of necrotic areas or intraduct surface; there was a strong correlation between HIF-1α–positive expression and CA IX–positive expression (P < 0.001), and higher Glut1 or CA IX expression grade was associated with lower microvessel density (MVD) value. In CT enhanced images, lower relative CT (rCT) values were associated with more significant necrosis in the tumor; rCT value correlated positively with MVD significantly (r = 0.319, P = 0.035), and higher Glut1 or CA IX expression grade correlated with lower rCT values (P = 0.001 and 0.003, respectively). Although high VEGF expression was significantly correlated with high HIF-1α expression (P < 0.001), there were no correlations between VEGF and MVD, and HIF-1α and MVD (P = 0.559 and 0.710, respectively), and the difference of the mean rCT value between high VEGF or HIF-1α expression group and low VEGF or HIF-1α expression group was not significant.

Conclusions In breast cancer tissues, Glut1 and CA IX are key hypoxia biomarkers. Importantly, detection of necrosis in breast cancer tissue via CT enhanced imaging may prognosticate hypoxia and angiogenesis status and help to determine treatment plan of advanced breast cancer.

From the *Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing; and †Department of Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, China.

Received for publication May 22, 2012; accepted October 17, 2012.

Reprints: Dehang Wang, MS, Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China (e-mail:

Author contributions: X.S. and Y.W. carried out the CT scan and CT images analysis, and drafted the manuscript. J.C. carried out immunohistochemistry. X.X. communicated with the patients for CT scan. Y.J. participated in the design of the study, Y.F. performed the statistical analysis. D.W. conceived of the study and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

This work was partly supported by the Center Institute of the Affiliated Renmin Hospital, Jiangsu University.

The authors declare that they have no conflicts of interest.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.