Practical problems in quantification of tissue vascularisation

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Abstract

The quantitative estimation of tissue vascularisation, especially in neoplasia has raised controversies in literature. Most authors indicate that the numerical density of microvessels may be helpful as independent prognostic factor in various types of cancer. Other authors report contrary results. In this review the methodological differences and details of quantification of the vascular bed especially in neoplasm are traced and the interpretation pitfalls are analyzed. Methodological inaccuracies which may influence on irreproducibility and decrease of the diagnostic value of the methods are discussed. The following proposals for methodological improvements are presented: (i) the characterization of the vascularisation of the neoplasm should be based on measurements done at two different, non parallel planes; (ii) the unbiased measurement frame of similar size of reference area (~0.5 mm²) should be routinely applied in diagnostic studies on neovascularisation; (iii) the measured features should reflect: angiogenesis (count of endothelial cells, or volume fraction or absolute volume of endothelial cells; when the numerical density is estimated a correction for vessel branches should be introduced); risk for metastasis (size distribution of vessels, at least two size classes: below 30 µm and more than 30 µm in diameter); level of tissue nutrition i.e. distinction between vascularisation and blood supply (calculation of the ratio of vessels with red cells to non-perfused vessels).

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Over : Krzysztof W. Zieliňski