Journal List > J Korean Soc Radiol > v.80(2) > 1138879

Lee, Kim, Kang, Lee, and Kim: Contrast-Enhanced Ultrasound Parameters in Breast Cancer: Correlations with Prognostic Factors



To correlate the value of contrast-enhanced ultrasound (CEUS) with prognostic factors of breast cancer.

Materials and Methods

24 breast cancer patients were evaluated with CEUS. As a quantitative analysis, the peak enhancement (PE), wash-in and wash-out area under curve (Wi-WoAUC), wash-in rate (WiR) and wash-out rate, rise time, fall time, mean transit time, time to peak, and wash-in perfusion index (WiPI) were measured. As a qualitative analysis, the enhancement patterns were evaluated. Pathologic prognostic factors, including histologic grade, hormonal receptors and Ki-67 proliferative index were assessed by immunohistochemistry. Correlation of quantitative and qualitative parameters of CEUS with prognostic factors was assessed.


We found that the quantitative CEUS values (PE, WiWoAUC, and WiPI) of estrogen receptor (ER) positive breast cancer were higher than those of ER negative counterpart (allp < 0.05). Lower quantitative CEUS values (PE, WiWoAUC, WiR, and WiPI) were found in triple-negative cancer (TNC) than those of non-TNC (allp < 0.05). No CEUS parameter showed significant difference in distinguishing histologic grade (allp > 0.05).


The CEUS parameters were helpful in predicting prognostic factors, such as ER positivity or triple negativity. However, they could not predict the histologic grade.


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Fig. 1.
An example of imaging analysis with advanced US quantification software (VueBox®). B mode US image shows ROI (purple line) drawn manually covering the entire tumor. In all cases, the depth was set to 4 cm. Static image of contrast enhanced US at the PE shows heterogeneous enhancement, perfusion defect (red arrow) and crab-claw enhancement (red arrowhead) at the periphery. Color map with PE shows variable enhancement in the tumor. Time-intensity curve is shown. And the PE value is shown (about 1401 au). PE = peak enhancement, ROI = regions of interest, US = ultrasound
Fig. 2.
Quantitative time-to-intensity curve parameters. FT = fall time, mTTL = mean transit time, PE = peak enhancement, RT = rise time, TTP = time to peak, WiAUC = wash-in area under curve, WiR = wash-in rate, WiWoAUC = wash-in and wash-out area under the curve, WoAUC = wash-out area under curve, WoR = wash-out rate
Fig. 3.
A 45-year-old woman presented with invasive ductal carcinoma, ER-positive type. The tumor showed a relatively high wash-in area under curve value (91280.77 au) of region of interest (purple circle). Other tumor characteristics were as follows: low histologic grade; ER positive; progesterone receptor positive; human epidermal growth factor receptor 2 negative; Ki-67 ≥ 14%; luminal subtype. Gray-scale breast US image shows an irregular hypoechoic mass. Contrast-enhanced US image shows heterogeneously hyper-enhanced mass with a local perfusion defect (red arrow). The scope of the lesion is larger than that shown by gray-scale US. Time-intensity curve shows peak intensity value (about 4627 au). ER = estrogen receptor, US = ultrasound
Fig. 4.
A 44-year-old woman presented with Rt breast cancer, ER-positive type. A. Mammography shows an indistinct oval equal density mass (arrow). B. Gray-scale breast US image shows an oval indistinct heterogeneous mass (central hypoechoic and peripheral hyperechoic) (arrows). C. Contrast-enhanced US image shows heterogeneously enhanced mass with a perfusion defect (red arrow) and crab-claw enhancement (red arrowheads) at the periphery. The scope of the lesion is slightly larger than it appears in the corresponding gray-scale US image. Time intensity curve shows peak intensity value (about 3164 au). The tumor showed a relatively high wash-in area under curve value (73005.78 au) of region of interest (purple circle). Other tumor characteristics were as follows: low histologic grade, ER positive, progesterone receptor positive, human epidermal growth factor receptor 2 negative, Ki-67 ≥ 14%, luminal subtype. ER = estrogen receptor, US = ultrasound
Fig. 5.
A 54-year-old woman presented with multi-centric breast cancer; invasive ductal carcinoma, triple negative subtype. The tumor showed a relatively low wash-in area under the curve, wash-out area under the curve, wash-in and wash-out area under the curve, wash-in perfusion index values of region of interest (purple circle). Other tumor characteristics were as follows: low histologic grade; estrogen receptor negative; progesterone receptor negative; human epidermal growth factor receptor 2 negative; Ki-67 ≥ 14%. Gray-scale breast US image shows an irregular indistinct hypoechoic mass. Contrast-enhanced US image shows relatively faint and heterogeneous enhancement. Time-intensity curve shows low peak intensity value (about 337 au). US = ultrasound
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