Top

European Radiology

Published in:

01-12-2013 | Breast

Correlation of contrast-enhanced ultrasound kinetics with prognostic factors in invasive breast cancer

Authors: Botond K. Szabó, Ariel Saracco, Ervin Tánczos, Peter Aspelin, Karin Leifland, Brigitte Wilczek, Rimma Axelsson

Published in: European Radiology | Issue 12/2013

Abstract

Objectives

To correlate contrast-enhanced ultrasound (CEUS) kinetic parameters with traditional and molecular prognostic factors in invasive breast cancer.

Methods

Seventy-five invasive breast cancers were evaluated with contrast harmonic imaging after the injection of a bolus dose of 2.4 ml sulphur hexafluoride microbubble contrast agent. The lognormal function was used for quantitative analysis of kinetic data. These parameters correlated with traditional prognostic factors (tumour size, histological type, tumour grade, axillary lymph node status) and immunohistochemical biomarkers (ER, PR and HER2 status).

Results

Statistically significant correlation was found between time-to-peak and tumour grade (P value = 0.023), PR status (P value = 0.042) and axillary node status (P value = 0.025). Wash-out ratio, measured at 21 s was significantly associated with ER status (P value = 0.042) and PR status (P value = 0.026).

Conclusions

Invasive breast carcinomas exhibiting earlier peak enhancement and faster elimination of microbubble contrast agent at CEUS are found to be associated with established predictors of poor prognosis.

Key Points

• Contrast-enhanced ultrasound (CEUS) can potentially determine the aggressiveness of invasive breast cancers.

• Early peak enhancement and accelerated wash-out at CEUS suggest poor prognosis.

• CEUS kinetics are similar to that of DCE-MRI in assessing tumour aggressiveness.

Skaane P, Sager EM, Olsen JB et al (1999) Diagnostic value of ultrasonography in patients with palpable mammographically noncalcified breast tumors. Acta Radiol 40:163–168PubMedCrossRef

Kedar RP, Cosgrove D, McCready VR, Bamber JC, Carter ER (1996) Microbubble contrast agent for color Doppler US: effect on breast masses. Work in progress. Radiology 198:679–686PubMed

Delorme S, Krix M (2006) Contrast-enhanced ultrasound for examining tumor biology. Cancer Imaging 6:148–152PubMedCrossRef

Cuenod CA, Fournier L, Balvay D, Guinebretière J (2006) Tumor angiogenesis: pathophysiology and implications for contrast-enhanced MRI and CT assessment. Abdom Imaging 31:188–193PubMedCrossRef

Lee T, Purdie TG, Stewart E (2003) CT imaging of angiogenesis. Q J Nucl Med 47:171–187PubMed

Griebel J, Mayr NA, de Vries A et al (1997) Assessment of tumor microcirculation: a new role of dynamic contrast MR imaging. J Magn Reson Imaging 7:111–119PubMedCrossRef

Anderson H, Price P, Blomley M, Leach MO, Workman P, Cancer Research Campaign PK/PD Technologies Advisory Committee (2001) Measuring changes in human tumour vasculature in response to therapy using functional imaging techniques. Br J Cancer 85:1085–1093PubMedCrossRef

Balleyguier C, Opolon P, Mathieu MC et al (2009) New potential and applications of contrast-enhanced ultrasound of the breast: own investigations and review of the literature. Eur J Radiol 69:14–23PubMedCrossRef

Hwang M, Niermann KJ, Lyshchik A, Fleischer AC (2009) Sonographic assessment of tumor response: from in vivo models to clinical applications. Ultrasound Q 25:175–183PubMedCrossRef

10.

Szabó BK, Aspelin P, Kristoffersen Wiberg M, Tot T, Boné B (2003) Invasive breast cancer: correlation of dynamic MR features with prognostic factors. Eur Radiol 13:2425–2435PubMedCrossRef

11.

Chang Y, Kwon KH, Choi DL et al (2009) Magnetic resonance imaging of breast cancer and correlation with prognostic factors. Acta Radiol 50:990–998PubMedCrossRef

12.

D’Onofrio M, Zamboni GA, Malagò R et al (2009) Resectable pancreatic adenocarcinoma: is the enhancement pattern at contrast-enhanced ultrasonography a pre-operative prognostic factor? Ultrasound Med Biol 35:1929–1937PubMedCrossRef

13.

Massironi S, Conte D, Sciola V et al (2010) Contrast-enhanced ultrasonography in evaluating hepatic metastases from neuroendocrine tumours. Dig Liver Dis 42:635–641PubMedCrossRef

14.

Ouyang Q, Chen L, Zhao H, Xu R, Lin Q (2010) Detecting metastasis of lymph nodes and predicting aggressiveness in patients with breast carcinomas. J Ultrasound Med 29:343–352PubMed

15.

Strouthos C, Lampaskis M, Sboros V, McNeilly A, Averkiou M (2010) Indicator dilution models for the quantification of microvascular blood flow with bolus administration of ultrasound contrast agents. IEEE Trans Ultrason Ferroelectr Freq Control 57:1296–1310PubMedCrossRef

16.

Saracco A, Szabo B, Aspelin P et al (2012) Differentiation between benign and malignant breast tumors using kinetic features of real-time harmonic contrast-enhanced ultrasound. Acta Radiol 53:382–388PubMedCrossRef

17.

Shah SS, Ketterling RP, Goetz MP et al (2010) Impact of American Society of Clinical Oncology/College of American Pathologists guideline recommendations on HER2 interpretation in breast cancer. Hum Pathol 41:103–106PubMedCrossRef

18.

Carmeliet P (2005) Angiogenesis in life, disease and medicine. Nature 438:932–936PubMedCrossRef

19.

Folkman J (1971) Tumor angiogenesis: therapeutic implications. N Engl J Med 285:1182–1186PubMedCrossRef

20.

Mann RM, Kuhl CK, Kinkel K, Boetes C (2008) Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 18:1307–1318PubMedCrossRef

21.

Kuhl CK (2000) MRI of breast tumors. Eur Radiol 10:46–58PubMedCrossRef

22.

Kuhl CK, Mielcareck P, Klaschik S et al (1999) Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110PubMedCrossRef

23.

Caproni N, Marchisio F, Pecchi A et al (2010) Contrast-enhanced ultrasound in the characterisation of breast masses: utility of quantitative analysis in comparison with MRI. Eur Radiol 20:1384–1395PubMedCrossRef

24.

Zhao H, Xu R, Ouyang Q, Chen L, Dong B, Huihua Y (2010) Contrast-enhanced ultrasound is helpful in the differentiation of malignant and benign breast lesions. Eur J Radiol 73:288–293PubMedCrossRef

25.

Uzzan B, Nicolas P, Cucherat M, Perret G (2004) Microvessel density as a prognostic factor in women with breast cancer: a systematic review of the literature and meta-analysis. Cancer Res 64:2941–2955PubMedCrossRef

26.

Delli Carpini J, Carpini JD, Karam AK, Montgomery L (2010) Vascular endothelial growth factor and its relationship to the prognosis and treatment of breast, ovarian, and cervical cancer. Angiogenesis 13:43–58PubMedCrossRef

27.

Knopp MV, Weiss E, Sinn HP et al (1999) Pathophysiologic basis of contrast enhancement in breast tumors. J Magn Reson Imaging 10:260–266PubMedCrossRef

28.

Frouge C, Guinebretière JM, Contesso G, Di Paola R, Bléry M (1994) Correlation between contrast enhancement in dynamic magnetic resonance imaging of the breast and tumor angiogenesis. Invest Radiol 29:1043–1049PubMedCrossRef

29.

Buadu LD, Murakami J, Murayama S et al (1996) Breast lesions: correlation of contrast medium enhancement patterns on MR images with histopathologic findings and tumor angiogenesis. Radiology 200:639–649PubMed

30.

Boné B, Szabó BK, Perbeck LG, Veress B, Aspelin P (2003) Can contrast-enhanced MR imaging predict survival in breast cancer? Acta Radiol 44:373–378PubMed

31.

Pickles MD, Manton DJ, Lowry M, Turnbull LW (2009) Prognostic value of pre-treatment DCE-MRI parameters in predicting disease free and overall survival for breast cancer patients undergoing neoadjuvant chemotherapy. Eur J Radiol 71:498–505PubMedCrossRef

32.

Du J, Li F, Fang H, Xia J, Zhu C (2008) Correlation of real-time gray scale contrast-enhanced ultrasonography with microvessel density and vascular endothelial growth factor expression for assessment of angiogenesis in breast lesions. J Ultrasound Med 27:821–831PubMed

Title: Correlation of contrast-enhanced ultrasound kinetics with prognostic factors in invasive breast cancer
Authors: Botond K. Szabó
Ariel Saracco
Ervin Tánczos
Peter Aspelin
Karin Leifland
Brigitte Wilczek
Rimma Axelsson
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 12/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-2960-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Correlation of contrast-enhanced ultrasound kinetics with prognostic factors in invasive breast cancer

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Please log in to get access to this content

Other articles of this Issue 12/2013

Computed diffusion-weighted imaging using 3-T magnetic resonance imaging for prostate cancer diagnosis

Whole-body diffusion-weighted imaging: is it all we need for detecting metastases in melanoma patients?

BOLD-MRI of breast invasive ductal carcinoma: correlation of R2* value and the expression of HIF-1α

MR-guided facet joint injection therapy using an open 1.0-T MRI system: an outcome study

Congenital anorectal atresia: MR imaging of late post-operative appearances in adult patients with anal incontinence

Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy