Angiogenesis is essential for tumor growth and metastasis, and several studies have reported increased angiogenesis, as quantified by microvessel density, to be a powerful prognostic tool in breast cancer. Therefore, there is considerable interest in automated assessment of microvessel density with possible benefits in improved accuracy, increased precision, and handling workload. Visual and automated assessment of microvessel density (CD34(+)) and survival were examined in patients with primary operable invasive ductal breast cancer. Tissue microarrays (n = 356 patients) immunostained for microvessel density (CD34(+)) were scored visually and automatically with the Slidepath Tissue IA system (Dublin, Ireland). Visual and automated microvessel density (CD34(+)) were in agreement (interclass correlation coefficient = 0.69, P < .001). Visual but not the automated method for microvessel density (CD34(+)) was associated with locoregional treatment and metastasis. On univariate survival analysis, visual but not automated method for microvessel density (CD34(+)) was associated with recurrence-free and cancer-specific survival in patients with invasive ductal breast cancer (P < .01). Although automated assessment of microvessel density (CD34(+)) is in reasonable agreement, it poorly predicts outcome in patients with operable invasive ductal breast cancer.
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