Power Doppler breast ultrasound: Association of vascularization and ER/c-erbB-2 co-expression in invasive breast carcinoma

Background: Angiogenesis is a fundamental component of oncogenesis. In this study we provided morphologic evidence of vascularization by using power Doppler ultrasound to correlate the clinicopathologic features of tumorigenesis, ER/c-erbB-2 expression, and tumor grade in invasive breast carcinoma. Methods: Three indices (VI, vascularization index; FI, flow index; VFI, vascularization flow index) were used to analyze 3D power Doppler ultrasound images from 168 patients with malignant breast carcinoma and to correlate their clinicopathologic features. Results: VI (the mean tumor vascularity) was correlated with ER negativity (p <0.0029) and VFI (the overall perfusion) was correlated with ER positivity (p <0.0029). HER2 positivity was statistically significantly correlated with tumor vasculature (VI, VFI) and tumor size/volume. FI (the mean blood flow volume) was significantly correlated with tumor size/volume, but VI was not. The univariate or multivariate logistic regression analysis also showed the reverse correlations between ER expression and tumor vascularity, and positive correlations between HER2 expression and tumor vascularity as well as tumor volume. Conclusions: This morphologic evidence of vascularization is correlated with tumor angiogenesis and ER/c-erbB-2 co-expression, which could clarify the biology of breast cancer.