Japanese Journal of Radiology

, Volume 37, Issue 2, pp 145–153 | Cite as

Perfusion contrast-enhanced ultrasound to predict early lymph-node metastasis in breast cancer

  • Naoko MoriEmail author
  • Shunji Mugikura
  • Minoru Miyashita
  • Yumiko Kudo
  • Mikiko Suzuki
  • Li Li
  • Yu Mori
  • Shoki Takahashi
  • Kei Takase
Original Article



To evaluate whether quantitative analysis of perfusion contrast-enhanced ultrasound (CE-US) could predict early lymph-node (LN) metastasis in clinically node-negative breast cancer.

Materials and methods

In this prospective study, 64 breast cancer patients were selected for perfusion CE-US imaging. Regions of interest were placed where the strongest and weakest signal increases were found to obtain peak intensities (PIs; PImax and PImin, respectively) for time–intensity curve analyzes. The PI difference and PI ratio were calculated as follows: PI difference = PImax−PImin; PI ratio = PImax/PImin.


Forty-seven cases were histologically diagnosed as negative for LN metastasis and 17 were positive. There was a significant difference in PImin and the PI ratio between the LN-negative and -positive metastasis groups (p = 0.0053 and 0.0082, respectively). Receiver-operating curve analysis revealed that the area under the curve of PImin and the PI ratio were 0.73 and 0.72, respectively. The most effective threshold for the PI ratio was 1.52, and the sensitivity, specificity, positive predictive value, and negative predictive value were 59% (10/17), 87% (41/47), 63% (10/16), and 85% (41/48), respectively.


Parameters from the quantitative analysis of perfusion CE-US imaging showed significant differences between the LN-negative and -positive metastasis groups in clinically node-negative breast cancer.


Breast cancer Lymph-node metastasis Ultrasound Contrast-enhanced ultrasound Microbubble 



Contrast-enhanced ultrasound


Lymph node


Peak intensities


Sentinel LN biopsy


Time–intensity curve


Microvessel density


Area under the curve


Regions of interest


Interclass correlation coefficient


Receiver-operating characteristic



This study was supported by JSPS KAKENHI 26461783 and 15K09913. The authors would like to thank Yumi Fujimoto in Tohoku University Hospital and Shomo Chou in Tohoku University for their kind support. We thank James P. Mahaffey, Ph.D., from Edanz Group ( for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

Naoko Mori has nothing to disclose. Shunji Mugikura has nothing to disclose. Minoru Miyashita has nothing to disclose. Yumiko Kudo has nothing to disclose. Mikiko Suzuki has nothing to disclose. Li Li has nothing to disclose. Yu Mori has nothing to disclose. Shoki Takahashi has nothing to disclose. Kei Takase has nothing to disclose.


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Copyright information

© Japan Radiological Society 2018

Authors and Affiliations

  1. 1.Department of Diagnostic RadiologyTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Department of Surgical OncologyTohoku University Graduate School of MedicineSendaiJapan
  3. 3.Department of Physiological Laboratory CenterTohoku University HospitalSendaiJapan
  4. 4.Department of Orthopedic SurgeryTohoku University Graduate School of MedicineSendaiJapan

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