Blood Flow Indices by Doppler Ultrasonography Vary with Neoadjuvant Chemotherapy but Are Not Related to Plasma VEGF Levels in Locally Advanced Breast Cancer

Abstract

Objective: The aim of our study was to assess the quantity of blood flow to malignant tissue by color Doppler ultrasonography, its correlation with plasma vascular endothelial growth factor (VEGF) levels and response to neoadjuvant chemotherapy of patients with locally advanced and inflammatory breast carcinoma. Methods: We measured blood velocity at peak systole (PSV), end-diastolic velocity and resistivity index [RI = (PSV – end-diastolic velocity)/PSV] by Doppler ultrasonography in primary tumors and/or axillary lymph nodes of patients before and after 2–4 cycles of anthracycline-containing neoadjuvant chemotherapy and basal plasma VEGF levels. Results: Of 21 patients with a median age of 42 years (range 26–68), 16 (76.2%) were premenopausal. Median basal RI was 0.70 (interquartile range 0.68–0.78) and PSV was 24.2 cm/s (interquartile range 18.7–56.6). The median measured VEGF level was 231.5 pg/ml (interquartile range 187.5–345.5). After 2–4 cycles of chemotherapy, 13 patients (61.9%) had partial remission and 8 (38.1%) were stable. Median basal RI (0.70, interquartile range 0.68–0.78) significantly decreased to 0.66 (interquartile range 0.59–073) after chemotherapy (p = 0.043). There was a trend that the greater the shrinkage of the tumor with chemotherapy, the lower the RI (r = 0.70, p = 0.078). Conclusion: The decrease in RI with chemotherapy, which means increased blood flow at diastole of the cardiac cycle into the tumoral tissue, may be related to decreased intratumoral pressure secondary to tumor shrinkage and may reflect a new type of response, that is vascular response.