Diagnostic and prognostic values of contrast-enhanced ultrasound in breast cancer: a retrospective study

Abstract

This study aimed to explore the diagnostic and prognostic values of contrast-enhanced ultrasound (CEUS) in breast cancer. Between September 2009 and October 2011, a total of 143 breast cancer patients and 161 healthy people were selected as case group and control group, respectively. After the identification of lesions by conventional ultrasound, all patients underwent CEUS. The CEUS images were analyzed, and time–intensity curves (TICs) were obtained. Hematoxylin–eosin and immunohistochemistry staining was performed on tissue specimens, according to which the expressions of estrogen receptor (ER), c-erb-B2, p53, and Ki-67 were measured. Multivariate logistic regression analysis was used to compare CEUS and TIC parameters between the two groups. Compared with the control group, cancer patients showed high enhancement, heterogeneous enhancement or defects in the central region, expansion of lesion diameter after enhancement and crab-like blur lesion edges. The peak intensity (PI), relative start time of enhancement, relative PI, and relative area under the curve in the case group were significantly higher than those in the control group. Logistic analysis showed that the uniformity of enhancement, expansion of lesion diameter, and relative PI were significant diagnostic parameters of breast cancer, with area under the curve being 0.798, 0.776, and 0.919, respectively. There were strong associations between CEUS characteristics and expressions of prognostic factors in breast cancer: the heterogeneous enhancement was common in c-erb-B2-positive tumors; the centripetal enhancement occurred more in ER-negative tumors; perforator vessels were often seen in tumors at high histological grade; perfusion defects were common in ER-negative, c-erb-B2-positive, and Ki-67-positive tumors. CEUS is a useful tool for the early diagnosis and prognosis of breast cancer.

Correlation Between Contrast-enhanced Ultrasound Characteristics (Qualitative and Quantitative) and Pathological Prognostic Factors in Breast Cancer

“…It is probable that angiogenic factors produced by more aggressive ER negative tumors, along with rapid growth of these tumors, result in blurred lesion margins in CEUS. Absence of ER expression has already been related to other qualitative and quantitative CEUS characteristics in literature, like more common perfusion defects (14,15,17) or centripetal enhancement (15), as well as higher PEAK intensity (13). To illustrate, perfusion defects are the result of rapid growth and active metabolism of malignant tumors, leading to insufficient vascular formation and nutrition supply and finally to central hypoxia and necrosis (38).…”

“…All the same, histologic grade has already been correlated with other qualitative CEUS characteristics in literature. To illustrate, Colpaert et al (37) found that tumors of higher histologic grade are more susceptible to central necrosis than tumors of lower histologic grade, while other researchers correlated penetrating vessels and perfusion defects with grade III tumors (14,15,17).…”

“…Positive Ki-67 expression corresponds to increased proliferation activity and poor prognosis (9,44). Zhao et al (14) and Cao et al (15) found that positive Ki-67 expression was correlated with perfusion defects in tumors, while Wan et al (17) argued that the ratio of the number of lesions with high microvessel density to the number of lesions with low microvessel density was higher in tumors with positive Ki-67 expression. In our study, positive Ki-67 expression correlated with perilesional enhancement.…”

“…There are few studies in literature exploring correlation between CEUS characteristics and pathological prognostic factors in breast cancer patients during the last six years, indicating a novel research area (13)(14)(15)(16)(17)(18)(19). Also, these studies have shown mixed results and have had differences in patients' populations, study design, statistical analysis etc.…”

“…Also, these studies have shown mixed results and have had differences in patients' populations, study design, statistical analysis etc. Indicatively, three studies have investigated only qualitative CEUS characteristics' correlation to pathological prognostic factors (14,15,18), two studies have investigated only quantitative CEUS characteristics' (13,16), and only two studies have investigated both quantitative and qualitative CEUS characteristics' (17,19).…”