الفهرس 
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Abstract
Introduction: It was documented that for any tumor to grow byond 12 mm, invade, metastasize, and produce symptoms, there must be expansion of its microvasculature by angiogenesis. Angiogenesis is a net balance between positive and negative forces. Recent studies showed that there is both prognostic and therapeutic value of tumor angiogenesis; the study of the microvessel density correlates with the prognosis, moreover the use of the antiangiogenic drugs can result in tumor regression especially if it is combined with the traditional chemotherapy. Patients and Methods: This study included 80 female patients with pathologically proved breast carcinoma selected by systemic random mehtod, those with metastases at presentation, excised mass, and those received preoperative therapy were excluded. All patients were fully investigated routinely, underwent modified radical mastectomy and received postoperative adjuvant therapy. All patients were followed up for 2 years for each case for detection of recurrence or distant metastases. The paraffin block of each case was stained by immunoperoxidase technique using the monoclonal antibodies againest factor VIII for determination of the angiogenesis grade and score in X400 field. Finally a univariate analysis was done to correlate the metastatic potential with the traditioinal clinicopathologic factors (T, N, G), the angigenesis grade, score and score groups (<10,1120, >21). Results: The results of this study showed the following: The relation of the tumor size and the metastatic potential was not significant (Pvalue with the tumor size groups was 0.09 and with the mean size in cm was 0.110). The same was with the tumor grade (Pvalue with the tumor grade groups was 0.182and with the mean grade was 0.24). Pvalue with the nodal groups was0.085 but on doing a ttest with the mean number of positive LN the Pvalue was significant (0.000). This is although with all these variables the Odds ratio was incraesing with increasing the variable. The same also was shown on doing barchart relation between these variables and the development of metastases. On studying the relation between the angiogenesis grade and the development of metastases there was a significant relation (Pvalue = 0.001), the same also was shown in the ttest for the mean values (2.75(R+(B0.82 in the nonmetastatic cases versus 3.48(R+(B0.6 in the metastatic cases with P=0.000). The ttest done for the maen value of the angiogenesis score in X400field showed a significant relation with the development of metastases (the score was 11.31(R+(B7.88 [range332] in the non metastatic cases versus 15.95(R+(B6.11[range825] in the metastatic cases with P=0.01). On classifying the score into groups, theChisquare test with metstases showed significant relation (P=0.023) and the Odds ratio was increasing by increasing the subgroup (3.02 from the first to the second and about 4 to the third group). On doing bar chart for this relation, the percentage of metastases was increasing progressively (43% in the group >21, 36% in the group 1120 and 16% in the group <10). The follow up period was 2 years; which is not sufficient for the correlation with the overall and disease free survivals. There were only 2 cases of local recurrence and 1 case of node negative metastatic patient, which are not sufficient to judge the importance of this test in these cases. Conclusions:?At the end of this study, it was concluded that the study of angiogenesis by grade and score in cases of breast carcinoma is an independent and statistically significant prognostic factor for the risk of metastases. It could be a valuable test for estimation of the risky group among those with node negative disease who deserves postoperative adjuvant systemic therapy. It was concluded also that the high count does not essentially mean that the case will be metastatic, on the other hand the low count does not rule out the possibility of metastases. It was concluded also that the estimation of the angiogenic protiens in urine and serum could be another window for research. It was concluded also that the use of the antiangiogenic drugs could be a new era in cancer management. Recommendations for the further studies of angiogenesis include; longer follow up period, wider area scanned from the tumor margin, more than one pathologist for the interprettation and finally combination of this test with other biological markers in multivariate analysis. Finally we recommend the use of this additional prognostic test routinely for every female suffering from breast cancer.