Academic radiology · 2026
Dominant Role of the Internal Mammary Artery in Breast Cancer Vascularization: A Dynamic MRI Study of Tumor-Induced Arterial Remodeling.
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Özmen Gizem, Tekcan Şanlı Deniz Esin, Şanlı Ahmet Necati, Arslan Engin
Аннотация
RATIONALE AND OBJECTIVES: This study aimed to investigate the alterations in the diameters of the internal mammary artery (IMA) and lateral thoracic artery (LTA) in newly diagnosed breast cancer patients, depending on tumor localization within the breast, using magnetic resonance imaging (MRI).
MATERIALS AND METHODS: This retrospective study included a total of 197 patients with breast MRI examinations available in the institutional database, comprising 163 patients with newly diagnosed, histopathologically confirmed breast cancer and 34 patients with benign breast lesions serving as the control group. Lesion-side and contralateral vessel diameters and their expansion ratios were analyzed according to intramammary lesion localization and clinicopathological factors. Lesion localization was categorized as lateral, medial, or central. IMA and LTA diameters were measured on original early post-contrast arterial-phase axial images (2nd-3rd dynamic series). All measurements were independently performed by two radiologists with different levels of experience (a senior breast radiologist and a 5th-year resident), blinded to each other's results.
RESULTS: In the malignant group, the median lesion-side IMA diameter was significantly larger than that of the contralateral side (3.4 mm [2.6-4.4] vs. 2.5 mm [2.0-3.1]), and a similar pattern was observed for the LTA (2.3 mm [1.8-2.8] vs. 2.0 mm [1.7-2.5]). The IMA demonstrated a greater relative increase compared to the LTA across all lesion localizations (p < 0.001). In contrast, no significant side-to-side vascular asymmetry or lesion-side arterial prominence was observed in patients with benign breast lesions, with vessel diameter ratios remaining close to unity. Interobserver agreement was excellent for IMA measurements (ICC = 0.92; 95% CI, 0.88-0.95) and good-to-excellent for LTA measurements (ICC = 0.87; 95% CI, 0.82-0.91).
CONCLUSION: Both the IMA and LTA demonstrated significantly increased diameters on the lesion side in breast cancer patients. The IMA showed a consistently greater relative increase than the LTA across different intramammary lesion localizations, supporting an IMA-predominant vascular remodeling pattern associated with malignancy. Notably, this unilateral vascular enlargement pattern was not observed in patients with benign breast lesions, suggesting that this phenomenon represents a tumor-associated vascular response specific to malignant processes. However, these findings currently have limited value in predicting tumor aggressiveness or nodal status.
MATERIALS AND METHODS: This retrospective study included a total of 197 patients with breast MRI examinations available in the institutional database, comprising 163 patients with newly diagnosed, histopathologically confirmed breast cancer and 34 patients with benign breast lesions serving as the control group. Lesion-side and contralateral vessel diameters and their expansion ratios were analyzed according to intramammary lesion localization and clinicopathological factors. Lesion localization was categorized as lateral, medial, or central. IMA and LTA diameters were measured on original early post-contrast arterial-phase axial images (2nd-3rd dynamic series). All measurements were independently performed by two radiologists with different levels of experience (a senior breast radiologist and a 5th-year resident), blinded to each other's results.
RESULTS: In the malignant group, the median lesion-side IMA diameter was significantly larger than that of the contralateral side (3.4 mm [2.6-4.4] vs. 2.5 mm [2.0-3.1]), and a similar pattern was observed for the LTA (2.3 mm [1.8-2.8] vs. 2.0 mm [1.7-2.5]). The IMA demonstrated a greater relative increase compared to the LTA across all lesion localizations (p < 0.001). In contrast, no significant side-to-side vascular asymmetry or lesion-side arterial prominence was observed in patients with benign breast lesions, with vessel diameter ratios remaining close to unity. Interobserver agreement was excellent for IMA measurements (ICC = 0.92; 95% CI, 0.88-0.95) and good-to-excellent for LTA measurements (ICC = 0.87; 95% CI, 0.82-0.91).
CONCLUSION: Both the IMA and LTA demonstrated significantly increased diameters on the lesion side in breast cancer patients. The IMA showed a consistently greater relative increase than the LTA across different intramammary lesion localizations, supporting an IMA-predominant vascular remodeling pattern associated with malignancy. Notably, this unilateral vascular enlargement pattern was not observed in patients with benign breast lesions, suggesting that this phenomenon represents a tumor-associated vascular response specific to malignant processes. However, these findings currently have limited value in predicting tumor aggressiveness or nodal status.