Abstract P1-02-04: Impact of perflubutane-enhanced ultrasonography for evaluating malignancy grade of breast cancer
Authors: Yoshimura Noriko , Masumoto Norio , Amioka Ai , Kajitani Keiko , Shigematsu Hideo , Emi Akiko , Kadoya Takayuki , Kataoka Tsuyoshi , Haruta Rumi , Okada Morihito 
Published: May 2015

Abstract
Objectives
This study aimed to determine whether or not signal intensity caused by the contrast effects of Contrast-enhanced ultrasonography (CEUS) using perflubutane could predict malignancy grades of invasive breast cancer.
Methods
Fifty-four patients with clinical stages I – III breast cancer between April 2013 and April 2014 underwent CEUS using perflubutane. We analyzed the assciation between contrast-effect intensity and contrast time in CEUS and the prognostic factors based on tumor size, nodal status and immunohistochemical markers (ER, HER-2 status, nuclear grade, Ki-67) in breast cancer.
Results
Time to washout of time required to reach plateau intensity from the start of the maximum intensity was significantly associated with the Ki-67 value (p = 0.03). Also, A parameter of intratumoral blood perfusion, peak intensity (PI), was significantly associated with the Ki-67 value (p = 0.006) and ER status (p = 0.002) (Table 1), but not with tumor size (cT; p = 0.25, pT; 0.96), node status (p = 0.99), HER-2 status (p = 0.32) and nuclear grade (p = 0.61).
Table 1. Relationship between changes in temporal contrast over time as a perfusion parameter and clinicopathological factorsFactorn(%)Peak intensityMean ± SDpMean age ± SD (y)53.8 ± 13.5&lt; 50 y30 (55.6)65.5 ± 25.40.50≥ 50 y24 (44.4)61.1 ± 21.5NG1 or 219 (35.2)65.8 ± 28.00.61335 (64.8)62.4 ± 21.2Ki67&lt; 3024 (44.4)53.8 ± 22.40.006≥ 3030 (55.6)71.4 ±21.9ERNegative13 (31.7)58.2 ± 20.90.002Positive41 (68.3)80.5 ± 24.6HER2Negative47 (87.0)62.3 ± 24.00.32Positive7 (13.0)71.9 ± 20.5ER: estrogen receptor, HER2: human epidermal growth factor receptor 2, NG: nuclear grade.
Also, Thirty-eight, 7, and 9 patients had luminal, HER-2-positive and triple-negative tumors, respectively. The PI values for these tumors were 56.8 ± 20.9, 71.9 ± 20.5, and 85.7 ± 23.2, respectively. And, the PI value was significantly greater in the triple-negative, than in luminal tumors (p = 0.001).
Table 2. Relationship between signal intensity as a perfusion parameter and tumor subtypesTumor subtypenPeak intensitySubtypeMean ± SDp *Luminal3856.8 ± 20.9HER-2-positive771.9 ± 20.50.09Triple-negative985.7 ± 23.20.001
Furthermore, PI significantly correlated with the Ki-67 value (Spearman r = 0.54, P = 0.00002).
Conclusions
These findings indicated that PI has excellent predictive value for grade malignancy in breast cancer and might help to determine appropriate therapeutic strategies.
Key points
• Contrast-enhanced ultrasonography (CEUS) enables the real-time evaluation of detailed hemodynamics in breast cancer.
• Peak intensity (PI) was significantly associated with Estrogen Receptors and Ki-67 assessed by immunohistochemistry.
• PI significantly correlated with the Ki-67 value, indicating that PI reflects the grade of proliferative activity in tumors.
• Analyses of contrast-effect intensity will be applied to evaluate grades of malignancy and determine treatment strategies.
Citation Format: Noriko Yoshimura, Norio Masumoto, Ai Amioka, Keiko Kajitani, Hideo Shigematsu, Akiko Emi, Takayuki Kadoya, Tsuyoshi Kataoka, Rumi Haruta, Morihito Okada. Impact of perflubutane-enhanced ultrasonography for evaluating malignancy grade of breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-02-04.