Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, Shanghai 200127, China.
Radiology. 2012 Feb;262(2):450-9. doi: 10.1148/radiol.11110789.
To investigate the correlation between enhancement patterns and parameters of contrast material-enhanced ultrasonography (US) with prognostic factors in breast cancers.
The study was approved by the institutional ethics committee, and written informed consent was obtained. Surgical resection specimens of 74 malignant breast lesions in 74 women (mean age, 55 years; age range, 32-78 years) who had undergone contrast-enhanced US were included. Different contrast enhancement patterns (enhancement degree, order, and margin; internal homogeneity; perfusion defect; and radial or penetrating vessels) and parameters (wash-in time, peak intensity, time to peak, area under the time-intensity curve, ascending slope, and descending slope) were evaluated. Pathologic prognostic factors, including histologic grade, lymph node status, tumor diameter, microvessel density (MVD), estrogen and progesterone receptor status, and c-erb-B2, p53, and Ki-67 expression were determined. Correlation of enhancement patterns and parameters with prognostic factors was analyzed with the Pearson χ2 test, Spearman rank correlation test, and logistic regression analysis.
Some enhancement features were associated, albeit not significantly, with prognostic factors. Perfusion defect was the most accurate enhancement criterion for higher histologic grade (grade III) (P=.016), negative estrogen receptor expression (P=.006), positive c-erb-B2 expression (P=.013), larger tumor diameter (≥2 cm) (P=.016), and increased MVD (P=.019). Radial or penetrating vessels were associated with lymph node status (P=.010). Hyperenhancement may be useful in reflecting increased MVD (P=.008) and positive p53 expression (P=.037). For contrast enhancement parameters, ascending slope was the best discrimination criterion for proliferative activity (P=.003).
Enhancement patterns and parameters of contrast-enhanced US may be useful in the noninvasive prediction of prognostic factors of breast cancers.
探讨乳腺癌增强超声造影（CEUS）增强模式与参数与预后因素的相关性。
本研究经机构伦理委员会批准，所有患者均签署了知情同意书。纳入 74 例 74 名女性患者（平均年龄 55 岁，年龄范围 32-78 岁）的乳腺癌手术切除标本，所有患者均接受了对比增强超声检查。评估不同的对比增强模式（增强程度、顺序和边缘；内部均匀性；灌注缺损；放射状或穿透性血管）和参数（灌注时间、峰值强度、达峰时间、时间-强度曲线下面积、上升斜率和下降斜率）。病理预后因素包括组织学分级、淋巴结状态、肿瘤直径、微血管密度（MVD）、雌激素和孕激素受体状态以及 c-erb-B2、p53 和 Ki-67 的表达。采用 Pearson χ2 检验、Spearman 秩相关检验和逻辑回归分析对增强模式和参数与预后因素的相关性进行分析。
一些增强特征与预后因素相关，但无统计学意义。灌注缺损是组织学分级（III 级）（P=.016）、雌激素受体阴性表达（P=.006）、c-erb-B2 阳性表达（P=.013）、肿瘤直径较大（≥2cm）（P=.016）和 MVD 增加（P=.019）的最佳增强标准。放射状或穿透性血管与淋巴结状态相关（P=.010）。高增强可能有助于反映 MVD 增加（P=.008）和 p53 阳性表达（P=.037）。对于增强参数，上升斜率是增殖活性的最佳判别标准（P=.003）。
CEUS 的增强模式和参数可能有助于无创预测乳腺癌的预后因素。
