Three-dimensional contrast enhanced ultrasound score and dynamic contrast-enhanced magnetic resonance imaging score in evaluating breast tumor angiogenesis: Correlation with biological factors

Abstract Objective To explore the clinical value of three-dimensional contrast enhanced ultrasound (3D-CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) score systems in evaluating breast tumor angiogenesis by comparing their diagnostic efficacy and correlation with biological factors. Methods 3D-CEUS was performed in 183 patients with breast tumors by Esaote Mylab90 with SonoVue (Bracco, Italy), DCE-MRI was performed on a dedicated breast magnetic resonance imaging (DBMRI) system (Aurora Dedicated Breast MRI Systems, USA) with a dedicated breast coil. 3D-CEUS and DCE-MRI score systems were created based on tumor perfusion and vascular characteristics. Microvessel density (MVD), vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMP-2, MMP-9) expression were measured by immunohistochemistry. Results Pathological results showed 35 benign and 148 malignant breast tumors. MVD ( P  = 0.000, r  = 0.76), VEGF ( P  = 0.000, r  = 0.55), MMP-2 ( P  = 0.000, r  = 0.39) and MMP-9 ( P  = 0.000, r  = 0.41) expression were all significantly different between benignity and malignancy. Regarding 3D-CEUS 4 points as cutoff value, the sensitivity, specificity and accuracy were 85.1%, 94.3% and 86.9%, respectively, and correlated well with MVD ( P  = 0.000, r  = 0.50), VEGF ( P  = 0.000, r  = 0.50), MMP-2 ( P  = 0.000, r  = 0.50) and MMP-9 ( P  = 0.000, r  = 0.66). Taking DCE-MRI 5 points as cutoff value, the sensitivity, specificity and accuracy were 86.5%, 94.3% and 88.0%, respectively and also correlated well with MVD ( P  = 0.000, r  = 0.52), VEGF ( P  = 0.000, r  = 0.44), MMP-2 ( P  = 0.000, r  = 0.42) and MMP-9 ( P  = 0.000, r  = 0.35). Conclusions 3D-CEUS score system displays inspiring diagnostic performance and good agreement with DCE-MRI scoring. Moreover, both score systems correlate well with MVD, VEGF, MMP-2 and MMP-9 expression, and thus have great potentials in tumor angiogenesis evaluation.