European Radiology

, Volume 23, Issue 12, pp 3228–3236 | Cite as

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

  • Botond K. SzabóEmail author
  • Ariel Saracco
  • Ervin Tánczos
  • Peter Aspelin
  • Karin Leifland
  • Brigitte Wilczek
  • Rimma Axelsson



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


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).


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).


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.


Breast cancer Ultrasound Contrast agents Kinetics Prognosis 



Dr. Saracco has received honoraria from Philips for lectures on contrast-enhanced ultrasound.

There is an overlap in patient cohort with an already published paper: Saracco A, Szabó BK, Aspelin P, Leifland K, Wilczek B, Celebioglu F, Axelsson R (2012) Differentiation between benign and malignant breast tumors using kinetic features of real-time harmonic contrast-enhanced ultrasound. Acta Radiol 53:382-388.

The aims and methods of the two papers are different, and there is an overlap in 75 malignant tumours. The CEUS kinetics were analysed with a more advanced mathematical modelling, and we correlated CEUS enhancement kinetics with prognostic factors in the recent study, whereas the purpose of the already published paper was to find out whether CEUS kinetics are able to differentiate between benign and malignant tumours.


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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Botond K. Szabó
    • 1
    Email author
  • Ariel Saracco
    • 2
  • Ervin Tánczos
    • 3
    • 4
  • Peter Aspelin
    • 2
  • Karin Leifland
    • 5
  • Brigitte Wilczek
    • 5
  • Rimma Axelsson
    • 2
  1. 1.Department of Radiology, Faculty of MedicineUniversity of SzegedSzegedHungary
  2. 2.Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
  3. 3.Bolyai Institute, Faculty of Science and InformaticsUniversity of SzegedSzegedHungary
  4. 4.Department of Medical Physics and Informatics, Faculty of MedicineUniversity of SzegedSzegedHungary
  5. 5.Division of Radiology, Department of Breast ImagingUnilabs Capio S:T Göran HospitalStockholmSweden

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