title: Intrinsic subtypes and tumor grades in breast cancer are associated with distinct 3-D power Doppler sonographic vascular features.
abstract: OBJECTIVE
  This study aimed to investigate the three-dimensional (3-D) power Doppler ultrasonographic (PDUS) vascular features of breast carcinoma according to intrinsic subtypes, nodal stage, and tumor grade.
  
  
  METHODS
  Total 115 receiving mastectomy breast carcinomas (mean size, 2.5 cm; range, 0.7-6.5 cm), including 102 invasive ductal carcinomas (IDC), 10 ductal carcinomas in situ (DCIS), and 3 invasive lobular carcinomas (ILC) diagnosed after mastectomy, were used in this retrospective study. Sixty IDC had nodal status and histopathologic tumor grades available for analysis. Vascular features, including number of vascular trees (NV), longest path length (LPL), total vessel length (TVL), number of bifurcations (NB), distance metric (DM), inflection count metric (ICM), vessel diameter (VD), and vessel-to-volume ratio (VVR) were extracted using 3-D thinning method. The Mann-Whitney U test, Student's t-test, one-way ANOVA, and Kruskal-Wallis test were performed as appropriate.
  
  
  RESULTS
  There was no significant difference of vascular features among IDC, DCIS and ILC. Except VD, vascular features in luminal type were significantly lower compared to HER2-enriched or triple negative types (p<0.05). Compared to ER+ (estrogen receptor positive) tumors, all features in ER- (estrogen receptor negative) tumors were significantly higher (p<0.01). Despite some significantly higher vascular features in high grade IDC compared to low and intermediate grade, there was no significant correlation between vascular features and nodal stages.
  
  
  CONCLUSIONS
  Differences in 3-D PDUS vascular features among intrinsic types of IDC are attributed to their ER status. Vascular features extracted by 3-D PDUS correlate with tumor grades but not nodal stage in IDC.
authors.affiliation: Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10041, Taiwan, ROC.
authors.forename: Yeun-Chung
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan, ROC.
authors.forename: Yao-Sian
authors.initials: YS
authors.lastname: Huang
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10041, Taiwan, ROC; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 10617, Taiwan, ROC.
authors.forename: Chiun-Sheng
authors.initials: CS
authors.lastname: Huang
authors.affiliation: Center for Functional Onco-Imaging and Department of Radiological Science, University of California Irvine, California, CA 92868, USA; Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan, ROC.
authors.forename: Jeon-Hor
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan, ROC; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 10617, Taiwan, ROC. Electronic address: rfchang@csie.ntu.edu.tw.
authors.forename: Ruey-Feng
authors.initials: RF
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D016217:Ultrasonography, Mammary
keywords: Biological tumor markers; Breast cancer; Doppler; Estrogen receptors; Vascular factor