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Usefulness of SonazoidR -enhanced ultrasonography in the evaluation of the biological features of breast cancer Norio Masumoto, Takayuki Kadoya, Ai Amioka, Keiko Kajitani, Akiko Emi, Hideo Shigematsu, Kazuo Matsuura, Rumi Haruta,Tsuyoshi Kataoka, Morihito Okada Department of Surgical Oncology, Hiroshima University, Japan. P
HIROSHIMA
UNIVERSITY
Background
Results
Biological markers of breast cancer, including hormone receptor, human epidermal growth factor receptor 2 (HER2), and tumor grade, Ki67 labelling index are known as prognostic factors and predictors of endocrine therapy, molecular targeted therapy and chemotherapy.
In addition, Ki67 labelling index is currently used to categorize as luminal A and B to decide the indication of chemotherapy
Contrast-enhanced ultrasonography (CEUS) using Sonazoid® enables to make real-time evaluation of vascularity in malignant tumors.
This study aimed to investigate whether or not  signal intensity caused by the contrast effects of Sonazoid® using CEUS could predict malignancy grade of breast cancer.
Association between IRB and clinicopathological factors in patients with breast cancer
The IRB in invasive breast cancer with high ki-67 and low ki-67 index
Correlation between IRB and Ki-67 in invasive breast cancer
Characteristic
n (%)
IRB
Mean ± SD　　　p
Mean age ± SD (y)
57.6 ± 10.9
<50 years
11 (34.4)
2.1 ± 1.0
0.11
≥50 years
21 (55.6)
3.2 ± 2.3
Histologic type
DCIS
9 (28.1)
1.6 ± 0.3
0.03
IDC
23 (61.9)
3.3 ± 2.2
Tumor stage
pT1
17 (74.9)
3.7 ± 2.4
0.18
pT2
6 (26.1)
2.3 ± 0.7
Nodal status
pN0
21 (91.3)
3.0 ± 1.9
pN1
2 (8.7)
6.0
Nuclear grade
Grade I, II
12 (52.2)
2.6 ± 1.0
0.10
Grade III
11 (47.8)
3.9 ± 2.9
Ki67
<30
9 (39.1)
2.4 ± 0.7
0.01
≥30
14 (60.9)
4.7 ± 2.9
ER Status
　 Positive
Negative
9.1
HER2 Status
3 (13.0)
3.4 ± 2.3
0.68
Positive
20 (87.0)
2.8 ± 0.4
Luminal type
Luminal A 14
Luminal B 4
3.9 ± 2.0
Patients & Methods
We underwent CEUS using Sonazoid ® in 32 patients with breast cancer between September 2012 and May Of these, 23 were diagnosed with invasive ductal carcinoma (IDC) and 9 were diagnosed with ductal carcinoma in situ (DCIS).
The HI VISION Ascendus (Hitachi Medical Corporation) was used for CEUS in this study. Tumors were observed 50 seconds after injection of 0.01 ml/kg of Sonazoid®.
We created a time–intensity curve of brightness on the time course of CEUS. As the parameter of blood perfusion in the tumor, the increasing rate of brightness (IRB) was calculated using the following formula:
IRB = Maximum intensity × 1/Intensity before contrast.
Summary
The IRB in breast cancer with DCIS and IDC
The IRB, used as the parameter of blood perfusion in the tumor, was 1.6 ± 0.3 and 3.3 ± 2.2 in patients with DCIS and IDC, respectively, suggestting that IDC have more blood flow compared with DCIS(P < 0.05).
IRB values were 2.4±0.7 (Luminal A) and 3.9±2.0 (Luminal B), respectively, indicating the significant difference between Luminal A and B (p = 0.03).
IRB value in the high Ki-67 group was significantly greater than that in the low Ki-67 group (p = 0.01). Furthermore, we found that IRB correlates with Ki-67 (Spearman r = 0.34, P = 0.11).
Analysis ​​of the time–intensity curves
Conclusions
IRB with CEUS using Sonazoid ® may exhibit correlation with Ki-67 labelling index and association with luminal subtypes, suggesting that IRB can be applied to the evaluation of malignancy grade of breast cancer.
Tumor stage, Nodal status, Nuclear grade, ki-67, ER Status,
HER2 Status and Luminal type were evaluated in IDC.
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