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PET/MRI of hypoxia and vascular function in ER-positive breast cancer: correlations with immunohistochemistry.

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Carmona-Bozo, Julia C 
Manavaki, Roido 
Miller, Jodi L 
Brodie, Cara 
Caracò, Corradina 


OBJECTIVES: To explore the relationship between indices of hypoxia and vascular function from 18F-fluoromisonidazole ([18F]-FMISO)-PET/MRI with immunohistochemical markers of hypoxia and vascularity in oestrogen receptor-positive (ER +) breast cancer. METHODS: Women aged  > 18 years with biopsy-confirmed, treatment-naïve primary ER + breast cancer underwent [18F]-FMISO-PET/MRI prior to surgery. Parameters of vascular function were derived from DCE-MRI using the extended Tofts model, whilst hypoxia was assessed using the [18F]-FMISO influx rate constant, Ki. Histological tumour sections were stained with CD31, hypoxia-inducible factor (HIF)-1α, and carbonic anhydrase IX (CAIX). The number of tumour microvessels, median vessel diameter, and microvessel density (MVD) were obtained from CD31 immunohistochemistry. HIF-1α and CAIX expression were assessed using histoscores obtained by multiplying the percentage of positive cells stained by the staining intensity. Regression analysis was used to study associations between imaging and immunohistochemistry variables. RESULTS: Of the lesions examined, 14/22 (64%) were ductal cancers, grade 2 or 3 (19/22; 86%), with 17/22 (77%) HER2-negative. [18F]-FMISO Ki associated negatively with vessel diameter (p = 0.03), MVD (p = 0.02), and CAIX expression (p = 0.002), whilst no significant relationships were found between DCE-MRI pharmacokinetic parameters and immunohistochemical variables. HIF-1α did not significantly associate with any PET/MR imaging indices. CONCLUSION: Hypoxia measured by [18F]-FMISO-PET was associated with increased CAIX expression, low MVD, and smaller vessel diameters in ER + breast cancer, further corroborating the link between inadequate vascularity and hypoxia in ER + breast cancer. KEY POINTS: • Hypoxia, measured by [18F]-FMISO-PET, was associated with low microvessel density and small vessel diameters, corroborating the link between inadequate vascularity and hypoxia in ER + breast cancer. • Increased CAIX expression was associated with higher levels of hypoxia measured by [18F]-FMISO-PET. • Morphologic and functional abnormalities of the tumour microvasculature are the major determinants of hypoxia in cancers and support the previously reported perfusion-driven character of hypoxia in breast carcinomas.



Breast cancer, Carbonic anhydrase IX, Hypoxia, Microvessel density, PET/MRI

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Eur Radiol

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Springer Science and Business Media LLC
This study was co-funded by Cancer Research UK (CRUK) – Cambridge Institute (CCCIT02) and the National Institute for Health and Care Research (NIHR) - Cambridge Biomedical Research Centre (BRC). J C Carmona-Bozo was supported by the Vargas Scholarship, Darwin College, University of Cambridge. R Manavaki and M J Graves are supported by NIHR Cambridge BRC. F J Gilbert is a Senior Investigator at NIHR Cambridge BRC. The University of Cambridge PET/MR facility was funded by the Medical Research Council (MRC), UK. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care, UK.