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Zarcaro C, Orlando AAM, Ferraro F, Donia S, Melita A, Micci G, Cannella R, Bartolotta TV. Breast multiparametric ultrasound: a single-center experience. J Ultrasound 2024:10.1007/s40477-024-00944-2. [PMID: 39103741 DOI: 10.1007/s40477-024-00944-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/30/2024] [Indexed: 08/07/2024] Open
Abstract
PURPOSE To evaluate the role of multiparametric ultrasound (mpUS) in the characterization of focal breast lesions (FBLs). METHODS This prospective study enrolled patients undergoing multiparametric breast ultrasound for FBLs. An experienced breast radiologist evaluated the following ultrasound features: US BI-RADS category, vascularization pattern (internal, vessels in rim and combined) and presence of penetrating vessels with each Doppler method (Color-Doppler, Power-Doppler, Microvascular imaging), strain ratio (SR) and Tsukuba score (TS) with Strain Elastography (SE), Emax, Emean, Emin and Eratio with 2D-shear wave elastography (2D-SWE). Core biopsy for all BI-RADS 4-5 FBLs and 24-month follow-up for all BI-RADS 2-3 FBLs were considered for standard of reference. The diagnostic performance was assessed with the area under curve (AUCs) and cut-off values were determined according to the Youden's index. RESULTS A total of 139 FBLs were included with 75/139 (53.9%) benign and 64/139 (46.1%) malignant FBLs. Internal vascularization patterns (p < 0.001), penetrating vessels (p < 0.001), TS 4-5 (p < 0.001) and all 2D-SWE parameters (p < 0.001) were significantly different between benign and malignant FBLs. The BI-RADS score provided an AUC of 0.876 (95% CI 0.810-0.926) for the diagnosis of malignant FBLs. Among the 2D-SWE measurements, an excellent diagnostic performance was observed for Emax with an AUC of 0.915 (95% CI 0.856-0.956) and Emean of 0.908 (95% CI 0.847-0.951). Optimal cutoff for the diagnosis of malignant FBLs were US BI-RADS > 3, Strain Ratio > 2.52, Tsukuba Score > 3, Emax > 82.6 kPa, Emean > 66.0 kPa, Emin > 54.4 kPa and Eratio > 330.8. Multiparametric ultrasound, particularly SWE, can improve specificity in the characterization of FBLs.
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Affiliation(s)
- Calogero Zarcaro
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy.
| | - Alessia Angela Maria Orlando
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy
| | - Fabiola Ferraro
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy
| | - Simona Donia
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy
| | - Arianna Melita
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Micci
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital "Policlinico P. Giaccone", Via Del Vespro 129, 90127, Palermo, Italy
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Eun NL, Bae SJ, Youk JH, Son EJ, Ahn SG, Jeong J, Kim JH, Lee Y, Cha YJ. Tumor-Infiltrating Lymphocyte Level Consistently Correlates with Lower Stiffness Measured by Shear-Wave Elastography: Subtype-Specific Analysis of Its Implication in Breast Cancer. Cancers (Basel) 2024; 16:1254. [PMID: 38610934 PMCID: PMC11011118 DOI: 10.3390/cancers16071254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: We aimed to elucidate the clinical significance of tumor stiffness across breast cancer subtypes and establish its correlation with the tumor-infiltrating lymphocyte (TIL) levels using shear-wave elastography (SWE). Methods: SWE was used to measure tumor stiffness in breast cancer patients from January 2016 to August 2020. The association of tumor stiffness and clinicopathologic parameters, including the TIL levels, was analyzed in three breast cancer subtypes. Results: A total of 803 patients were evaluated. Maximal elasticity (Emax) showed a consistent positive association with an invasive size and the pT stage in all cases, while it negatively correlated with the TIL level. A subgroup-specific analysis revealed that the already known parameters for high stiffness (lymphovascular invasion, lymph node metastasis, Ki67 levels) were significant only in hormone receptor-positive and HER2-negative breast cancer (HR + HER2-BC). In the multivariate logistic regression, an invasive size and low TIL levels were significantly associated with Emax in HR + HER2-BC and HER2 + BC. In triple-negative breast cancer, only TIL levels were significantly associated with low Emax. Linear regression confirmed a consistent negative correlation between TIL and Emax in all subtypes. Conclusions: Breast cancer stiffness presents varying clinical implications dependent on the tumor subtype. Elevated stiffness indicates a more aggressive tumor biology in HR + HER2-BC, but is less significant in other subtypes. High TIL levels consistently correlate with lower tumor stiffness across all subtypes.
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Affiliation(s)
- Na Lae Eun
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (N.L.E.); (J.H.Y.); (E.J.S.)
| | - Soong June Bae
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (S.J.B.); (S.G.A.); (J.J.); (J.H.K.)
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (N.L.E.); (J.H.Y.); (E.J.S.)
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (N.L.E.); (J.H.Y.); (E.J.S.)
| | - Sung Gwe Ahn
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (S.J.B.); (S.G.A.); (J.J.); (J.H.K.)
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Joon Jeong
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (S.J.B.); (S.G.A.); (J.J.); (J.H.K.)
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Jee Hung Kim
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (S.J.B.); (S.G.A.); (J.J.); (J.H.K.)
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Yangkyu Lee
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (S.J.B.); (S.G.A.); (J.J.); (J.H.K.)
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Yoon Jin Cha
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (S.J.B.); (S.G.A.); (J.J.); (J.H.K.)
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
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Kim HJ, Kim HH, Choi WJ, Chae EY, Shin HJ, Cha JH. Correlation of shear-wave elastography parameters with the molecular subtype and axillary lymph node status in breast cancer. Clin Imaging 2023; 101:190-199. [PMID: 37418896 DOI: 10.1016/j.clinimag.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE To examine correlations between shear-wave elastography (SWE) parameters with molecular subtype and axillary lymph node (LN) status of breast cancer. METHODS We retrospectively analyzed 545 consecutive women (mean age, 52.7 ± 10.7 years; range, 26-83) with breast cancer who underwent preoperative breast ultrasound with SWE between December 2019 and January 2021. SWE parameters (Emax, Emean, and Eratio) and the histopathologic information from surgical specimens including histologic type, histologic grade, size of invasive cancer, hormone receptor and HER2 status, Ki-67 proliferation index, and axillary LN status were analyzed. The relationships between SWE parameters and histopathologic findings were analyzed using an independent sample t-test, one-way ANOVA test with Tukey's post hoc test, and logistic regression analyses. RESULTS Higher stiffness values of SWE were associated with larger lesion size (>20 mm) on ultrasound, high histologic grade, larger invasive cancer size (>20 mm), high Ki-67, and axillary LN metastasis. Emax and Emean were the lowest in the luminal A-like subtype, and all three parameters were the highest in the triple-negative subtype. Lower value of Emax was independently associated with the luminal A-like subtype (P = 0.04). Higher value of Emean was independently associated with axillary LN metastasis for tumors ≤ 20 mm (P = 0.03). CONCLUSION Increases in the tumor stiffness values on SWE were significantly associated with aggressive histopathologic features of breast cancer. Lower stiffness values were associated with the luminal A-like subtype, and tumors with higher stiffness values were associated with axillary LN metastasis in small breast cancers.
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Affiliation(s)
- Hee Jeong Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
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Li J, Sun B, Li Y, Li S, Wang J, Zhu Y, Lu H. Correlation analysis between shear-wave elastography and pathological profiles in breast cancer. Breast Cancer Res Treat 2023; 197:269-276. [PMID: 36374375 DOI: 10.1007/s10549-022-06804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore the correlation between shear-wave elastography (SWE) parameters and pathological profiles of invasive breast cancer. METHODS A total of 197 invasive breast cancers undergoing preoperative SWE and primary surgical treatment were included. Maximum elastic modulus (Emax), mean elastic modulus (Emean), and elastic modulus standard deviation (Esd) were calculated by SWE. Pathological profile was gold standard according to postoperative pathology. The relationship between SWE parameters and pathological factors were analyzed using univariate and multivariate analysis. RESULTS In univariate analysis, large cancers showed significantly higher Emax, Emean and Esd (all P < 0.001). Emax and Esd in the group of histological grade III were higher than those in the group of grade I (both P < 0.05). Invasive lobular carcinomas (ILC) showed higher Emean than invasive ductal carcinoma (IDC) (P < 0.001). Lymphovascular invasion (LVI) group showed higher Emax values than negative group (P < 0.05). Emax, Emean and Esd of the Ki-67 positive group presented higher values than negative group (all P < 0.05). Androgen receptor (AR) positive lesions had lower Esd than AR negative lesions (P < 0.05). In multivariate analysis, invasive size independently influenced Emax (P < 0.001). Invasive size and pathological type both independently influenced Emean (both P < 0.001). Invasive size and AR status were both independently influenced Esd (both P < 0.05). CONCLUSION SWE parameters correlated with pathological profiles of invasive breast cancer.In particular, AR positive group showed significantly low Esd than negative group.
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Affiliation(s)
- Junnan Li
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Bo Sun
- The Second Department of Breast Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yanbo Li
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Shuang Li
- Department of Bone and Tissue Oncology, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jiahui Wang
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Ying Zhu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China. .,Tianjin Medical University Cancer Institute and Hospital, West Huan-Hu Rd, Ti Yuan Bei, Hexi District, Tianjin, 300060, People's Republic of China.
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Orguc S, Açar ÇR. Correlation of Shear-Wave Elastography and Apparent Diffusion Coefficient Values in Breast Cancer and Their Relationship with the Prognostic Factors. Diagnostics (Basel) 2022; 12:diagnostics12123021. [PMID: 36553027 PMCID: PMC9776617 DOI: 10.3390/diagnostics12123021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Diffusion-weighted imaging and elastography are widely accepted methods in the evaluation of breast masses, however, there is very limited data comparing the two methods. The apparent diffusion coefficient is a measure of the diffusion of water molecules obtained by diffusion-weighted imaging as a part of breast MRI. Breast elastography is an adjunct to conventional ultrasonography, which provides a noninvasive evaluation of the stiffness of the lesion. Theoretically, increased tissue density and stiffness are related to each other. The purpose of this study is to compare MRI ADC values of the breast masses with quantitative elastography based on ultrasound shear wave measurements and to investigate their possible relation with the prognostic factors and molecular subtypes. Methods: We retrospectively evaluated histopathologically proven 147 breast lesions. The molecular classification of malignant lesions was made according to the prognostic factors. Shear wave elastography was measured in kiloPascal (kPa) units which is a quantitative measure of tissue stiffness. DWI was obtained using a 1.5-T MRI system. Results: ADC values were strongly inversely correlated with elasticity (r = −0.662, p < 0.01) according to Pearson Correlation. In our study, the cut-off value of ADC was 1.00 × 10−3 cm2/s to achieve a sensitivity of 84.6% and specificity of 75.4%, and the cut-off value of elasticity was 105.5 kPa to achieve the sensitivity of 96.3% and specificity 76.9% to discriminate between the malignant and benign breast lesions. The status of prognostic factors was not correlated with the ADC values and elasticity. Conclusions: Elasticity and ADC values are correlated. Both cannot predict the status of prognostic factors and differentiate between molecular subtypes.
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Bartolotta TV, Orlando AAM, Dimarco M, Zarcaro C, Ferraro F, Cirino A, Matranga D, Vieni S, Cabibi D. Diagnostic performance of 2D-shear wave elastography in the diagnosis of breast cancer: a clinical appraisal of cutoff values. Radiol Med 2022; 127:1209-1220. [DOI: 10.1007/s11547-022-01546-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
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Are Mutation Carrier Patients Different from Non-Carrier Patients? Genetic, Pathology, and US Features of Patients with Breast Cancer. Cancers (Basel) 2022; 14:cancers14112759. [PMID: 35681739 PMCID: PMC9179636 DOI: 10.3390/cancers14112759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study is to evaluate the relationship between the pathogenic/likely pathogenic mutations, US features, and histopathologic findings of breast cancer in mutation carriers compared to non-carrier patients. Methods: In this retrospective study, we identified 264 patients with breast cancer and multigene panel testing admitted to our clinic from January 2018 to December 2020. Patient data US findings, US assessment of the axilla, multigene panel tests, histopathology, and immunochemistry reports were reviewed according to the BI-RADS lexicon. Results: The study population was comprised of 40% pathogenic mutation carriers (BRCA1, BRCA2, CHEK2, ATM, PALB, TP 53, NBN, MSH, BRIP 1 genes) and 60% mutation-negative patients. The mean patient age was 43.5 years in the carrier group and 44 years in the negative group. Carrier patients developed breast cancer with benign morphology (acoustic enhancement, soft elastography appearance) compared to non-carriers (p < 0.05). A tendency towards specific US features was observed for each mutation. BRCA1 carriers were associated with BC with microlobulated margins, hyperechoic rim, and soft elastography appearance (p < 0.05). Estrogen receptor (ER)-negative tumors were associated with BRCA1, TP53, and RAD mutations, while BRCA2 and CHEK2 were associated with ER-positive tumors. Conclusions: Patients with pathogenic mutations may exhibit BC with benign US features compared to negative, non-carrier patients. BRCA1, TP53, and RAD carriers account for up to one third of the ER tumors from the carrier group. Axillary US performed worse in depicting involved lymph nodes in carrier patients, compared to negative patients.
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Liu C, Zhou J, Chang C, Zhi W. Feasibility of Shear Wave Elastography Imaging for Evaluating the Biological Behavior of Breast Cancer. Front Oncol 2022; 11:820102. [PMID: 35155209 PMCID: PMC8830494 DOI: 10.3389/fonc.2021.820102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/30/2021] [Indexed: 12/27/2022] Open
Abstract
Objective To explore the feasibility of shear wave elastography (SWE) parameters for assessing the biological behavior of breast cancer. Materials and Methods In this prospective study, 224 breast cancer lesions in 216 female patients were examined by B-mode ultrasound and shear wave elastography in sequence. The maximum size (Smax) of the lesion was measured by B-mode ultrasound, and then shear wave elastography was performed on this section to obtain relevant parameters, including maximum elasticity (Emax), mean elasticity (Emean), standard deviation of elasticity (SD), and the area ratio of shear wave elastography to B-mode ultrasound (AR). The relationship between SWE parameters and pathological type, histopathological classification, histological grade, lymphovascular invasion status (LVI), axillary lymph node status (ALN), and immunohistochemistry of breast cancer lesions was performed according to postoperative pathology. Results In the univariate analysis, the pathological type and histopathological classification of breast cancer were not significantly associated with SWE parameters; with an increase in the histological grade of invasive ductal carcinoma (IDC), SD (p = 0.016) and Smax (p = 0.000) values increased. In the ALN-positive group, Smax (p = 0.004) was significantly greater than in the ALN-negative group; Smax (p = 0.003), Emax (p = 0.034), and SD (p = 0.045) were significantly higher in the LVI-positive group than in the LVI-negative group; SD (p = 0.043, p = 0.047) and Smax (p = 0.000, p = 0.000) were significantly lower in the ER+ and PR+ groups than in the ER- and PR- groups, respectively; AR (p = 0.032) was significantly higher in the ER+ groups than in the ER- groups, and Smax (p = 0.002) of the HER2+ group showed higher values than that of the HER2- group; Smax (p = 0.000), SD (p = 0.006), and Emax (p = 0.004) of the Ki-67 high-expression group showed significantly higher values than those of the Ki-67 low-expression group. In the multivariate analysis, Ki-67 was an independent factor of Smax (p = 0.005), Emax (p = 0.004), and SD (p = 0.006); ER was an independent influencing factor of Smax (p = 0.000) and AR (p = 0.032). LVI independently influences Smax (p = 0.006). Conclusions The SWE parameters Emax, SD, and AR can be used to evaluate the biological behavior of breast cancer.
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Affiliation(s)
- Chaoxu Liu
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenxiang Zhi
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
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Gu J, Polley EC, Boughey JC, Fazzio RT, Fatemi M, Alizad A. Prediction of Invasive Breast Cancer Using Mass Characteristic Frequency and Elasticity in Correlation with Prognostic Histologic Features and Immunohistochemical Biomarkers. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2193-2201. [PMID: 33994231 PMCID: PMC8243825 DOI: 10.1016/j.ultrasmedbio.2021.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 05/17/2023]
Abstract
This purpose of this study is to correlate a new shear-wave elastography (SWE) parameter, mass characteristic frequency (fmass) and other elasticity measure with the prognostic histological factors and immunohistochemical (IHC) biomarkers for the evaluation of heterogeneous breast carcinomas. The new parameter, fmass, first introduced in this paper, is defined as the ratio of the averaged minimum shear wave speed taken spatially within regions of interest to the largest mass dimension. 264 biopsy-proven breast cancerous masses were included in this study. Mean (Emean), maximum (Emax), minimum (Emin) shear wave elasticity and standard deviation (Esd) of shear wave elasticity were found significantly correlated with tumor size, axillary lymph node (ALN) status, histological subtypes and IHC subtypes. The areas under the curve for the ALN prediction are 0.73 (95% confidence interval [CI]: 0.67-0.80) and 0.75 (95% CI: 0.69-0.81) for the combination of Emean with Breast Imaging Reporting and Data System (BI-RADS) score and Emax with BI-RADS score, respectively. fmass was significantly correlated with the presence of calcifications, ALN status, histological grade, the expressions of IHC biomarkers and IHC subtypes. To conclude, poor prognostic factors were associated with high shear wave elasticity values and low mass characteristic frequency value. Therefore, SWE provides valuable information that may help with prediction of breast cancer invasiveness.
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Affiliation(s)
- Juanjuan Gu
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Eric C Polley
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Judy C Boughey
- Division of Subspecialty General Surgery, Department of General Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
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Peker A, Balci P, Basara Akin I, Özgül HA, Aksoy SÖ, Gürel D. Shear-Wave Elastography-Guided Core Needle Biopsy for the Determination of Breast Cancer Molecular Subtype. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1183-1192. [PMID: 32918306 DOI: 10.1002/jum.15499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate whether shear-wave elastography (SWE) guidance during core-needle biopsy can improve diagnostic accuracy and accurate determination of the molecular subtypes of breast cancer. METHODS This controlled, randomized prospective cohort study included 58 patients (mean age: 56.9 ± 16.2) who were referred for image-guided core-needle biopsy between May 2018 and April 2019 for lesions larger than 1 cm. In Group 1, 30 lesions were biopsied without SWE guidance and recorded as Biopsy A. In Group 2, 30 lesions were examined with SWE before biopsy, and then two different parts of the lesions were biopsied; biopsies from the relatively rigid areas of the lesions were recorded as Biopsy B, and biopsies from the less rigid areas of the lesions were recorded as Biopsy C. The histopathological and immunohistochemical results of biopsies were compared with the surgical results. RESULTS The sensitivity of Biopsy A, B and C were 96.7%, 100% and 100%, respectively. The benign-malignant concordance rates were 94.7%, 100%, and 90% and the diagnostic concordance rates were 89.5%, 100%, and 90% in Biopsies A, B, and C, respectively. When the 10% differences in the estrogen receptor (ER), progesterone receptor (PR), and Ki67 rates were considered significant, the concordance rate of ER was highest in Biopsy B (77.8%; p = 0.040). The concordance rate of immunohistochemical subtyping was 100% in Biopsy B and 71.4% in Biopsies A and C (p = 0.086). CONCLUSION SWE-guided core-needle biopsy of breast lesions increased the sensitivity, diagnostic accuracy, and accuracy of immunohistochemical subtyping to 100%.
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Affiliation(s)
- Ahmet Peker
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Pınar Balci
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Isil Basara Akin
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Hakan A Özgül
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Süleyman Ö Aksoy
- Department of Genereal Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Duygu Gürel
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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Fang JX, Chen XY, Yang QM, Xue MH. Factors Influencing Renal Parenchymal Stiffiness in Patients with Diabetic Nephropathy. Int J Gen Med 2021; 14:1911-1917. [PMID: 34040423 PMCID: PMC8140885 DOI: 10.2147/ijgm.s311420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal resilience. The purpose of this study is to determine the factors influencing renal resilience in patients with diabetic nephropathy (DN). Methods We recruited 56 healthy volunteers and 187 patients with DN. All the participants were evaluated using shear-wave elastography (SWE), and the size of their kidneys and Young's modulus values for the parenchyma were recorded. A total of 187 patients with DN are allocated to three groups according to their urinary albumin-to-creatinine ratio: normoalbuminuric (<30 mg/g creatinine), microalbuminuric (30-300 mg/g), and macroalbuminuric (≥300 mg/g) groups. Renal resilience is compared between the stages of diabetic nephropathy and the healthy control group, and the factors affecting the stiffiness of the renal parenchyma in DN are analyzed. Results The renal parenchyma is harder in participants with DN than in healthy participants (P < 0.001), and the stiffiness increases with the progression of the disease (P < 0.001). Multivariate logistic regression analysis shows that disease stage (β = 0.789, P < 0.001), duration of diabetes (β = 0.028, P < 0.001), and serum creatinine (SCr) concentration (β = 0.001, p < 0.001) influence the stiffiness of the renal parenchyma. Conclusion We show that SWE can be used to measure changes in the stiffiness of the renal parenchyma in patients with DN. Furthermore, Young's modulus of the renal parenchyma is related to the duration of diabetes, urinary albumin excretion, and SCr concentration. Thus, SWE can be used to objectively and non-invasively stage DN.
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Affiliation(s)
- Jian-Xiu Fang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Xiao-Yan Chen
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Qing-Mei Yang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
| | - Meng-Hua Xue
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, People's Republic of China
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Zubair M, Wang S, Ali N. Advanced Approaches to Breast Cancer Classification and Diagnosis. Front Pharmacol 2021; 11:632079. [PMID: 33716731 PMCID: PMC7952319 DOI: 10.3389/fphar.2020.632079] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
The International Agency for Research on Cancer (IARC) has recently reported a 66% increase in the global number of cancer deaths since 1960. In the US alone, about one in eight women is expected to develop invasive breast cancer(s) (breast cancer) at some point in their lifetime. Traditionally, a BC diagnosis includes mammography, ultrasound, and some high-end molecular bioimaging. Unfortunately, these techniques detect BC at a later stage. So early and advanced molecular diagnostic tools are still in demand. In the past decade, various histological and immuno-molecular studies have demonstrated that BC is highly heterogeneous in nature. Its growth pattern, cytological features, and expression of key biomarkers in BC cells including hormonal receptor markers can be utilized to develop advanced diagnostic and therapeutic tools. A cancer cell's progression to malignancy exhibits various vital biomarkers, many of which are still underrepresented in BC diagnosis and treatment. Advances in genetics have also enabled the development of multigene assays to detect genetic heterogeneity in BC. However, thus far, the FDA has approved only four such biomarkers-cancer antigens (CA); CA 15-3, CA 27-29, Human epidermal growth factor receptor 2 (HER2), and circulating tumor cells (CTC) in assessing BC in body fluids. An adequately structured portable-biosensor with its non-invasive and inexpensive point-of-care analysis can quickly detect such biomarkers without significantly compromising its specificity and selectivity. Such advanced techniques are likely to discriminate between BC and a healthy patient by accurately measuring the cell shape, structure, depth, intracellular and extracellular environment, and lipid membrane compositions. Presently, BC treatments include surgery and systemic chemo- and targeted radiation therapy. A biopsied sample is then subjected to various multigene assays to predict the heterogeneity and recurrence score, thus guiding a specific treatment by providing complete information on the BC subtype involved. Thus far, we have seven prognostic multigene signature tests for BC providing a risk profile that can avoid unnecessary treatments in low-risk patients. Many comparative studies on multigene analysis projected the importance of integrating clinicopathological information with genomic-imprint analysis. Current cohort studies such as MINDACT, TAILORx, Trans-aTTOM, and many more, are likely to provide positive impact on long-term patient outcome. This review offers consolidated information on currently available BC diagnosis and treatment options. It further describes advanced biomarkers for the development of state-of-the-art early screening and diagnostic technologies.
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Affiliation(s)
- M. Zubair
- Department of Biology, University of Arkansas at Little Rock, Little Rock, AR, United States
| | - S. Wang
- Department of Chemistry, University of Arkansas at Little Rock, Little Rock, AR, United States
| | - N. Ali
- Department of Biology, University of Arkansas at Little Rock, Little Rock, AR, United States
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Hu XQ, Peng L, Wintermark M, Lipson JA, Zhang YR, Gao Y. Shear Wave Elastography of Invasive Ductal Carcinoma: Correlations between Shear Wave Velocity and Histological Prognostic Factors. Curr Med Sci 2021; 41:173-179. [PMID: 33582923 DOI: 10.1007/s11596-021-2333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/14/2020] [Indexed: 10/22/2022]
Abstract
The correlations between shear wave velocity (SWV) calculated from virtual touch tissue imaging quantification (VTIQ) technique and histological prognostic factors of invasive ductal carcinoma was investigated. A total of 76 breast tumors histologically confirmed as invasive ductal carcinomas were included in this study. SWV values were measured by VTIQ for each lesion preoperatively or prior to breast biopsy. The maximum values were recorded for statistical analysis. Medical records were reviewed to determine tumor size, histological grade, lymph node status and immunohistochemical results. Tumor subtypes were categorized as luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) positive and triple negative. The correlations between SWV and histological prognostic factors were analyzed. It was found that tumor size showed positive association with SWV (r=0.465, P<0.001). Larger tumors had significantly higher SWV than smaller ones (P=0.001). Histological grade 1 tumors had significantly lower SWV values than those with higher histological grade (P=0.015). The Ki67 expression, tumor subtypes and lymph node status showed no statistically significant correlations with SWV, although triple negative tumors and lymph node-positive tumors showed higher SWV values. It was concluded that tumor size was significantly associated with SWV. Higher histological grade was associated with increased SWV. There was no statistically significant correlations between SWV and other histological prognostic factors.
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Affiliation(s)
- Xiao-Qing Hu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li Peng
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University, Palo Alto, California, USA
| | - Jafi Alyssa Lipson
- Department of Radiology, Stanford University, Palo Alto, California, USA
| | - Yan-Rong Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Radiology, Neuroradiology Section, Stanford University, Palo Alto, California, USA
| | - Yuan Gao
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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14
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Wang H, Li CY, Zha HL, Xu D, Hu ZB. Diagnostic and Predictive Values of Strain Ratios in the Regions of Interests in Reference Tissue for Breast Tumor. Cancer Manag Res 2021; 13:1017-1028. [PMID: 33574701 PMCID: PMC7871176 DOI: 10.2147/cmar.s292944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/08/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To investigate the diagnostic and predictive value of strain ratios in the regions of interests (ROIs) in reference tissue for breast tumor. PATIENTS AND METHODS A total of 707 lesions in 665 consecutive patients were examined with B-mode Breast Imaging-Reporting and Data System (BI-RADS) and Ultrasonic elastography (UE). Elasticity score (ES) and strain ratio (SR) in each lesion were calculated. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of BI-RADS, ES, SR1, SR2, BI-RADS combined with ES (BI-RADS+ES), BI-RADS combined with SR1 (BI-RADS+SR1), and BI-RADS combined with SR2 (BI-RADS+SR2). The sensitivity, specificity, and areas under the ROC curves (Az) were obtained. Scatter plots were generated to demonstrate the correlation between SR1 and SR2. Kruskal-Walls H-test, Mann-Whitney U-test and one-way ANOVA were performed to evaluate SRs and tumor-related variables. Multiple linear regression analysis was carried out to determine variables independently associated with SRs. RESULTS BI-RADS had high sensitivity and low specificity in the diagnosis of breast tumor. The specificity of BI-BADS combined with ES or SR was even higher. The Az value of BI-RADS+ES or BI-RADS+SRs was higher than that of BI-RADS (P < 0.001). The Az value of ES was higher than those of SR1 and SR2 (P < 0.001), and those of SR1 and SR2 were similar. SR1 and SR2 were highly positively correlated. There was no statistical difference between Az values of BI-RADS+ES, BI-RADS+SR1, and BI-RADS+SR2. Indistinct margin, high histologic grade, histological type, and negative human epidermal growth factor receptor (Her-2) were associated with SR1 and SR2. Progesterone receptor (PR) status and molecular subtype were associated with SR2. Histologic grade and tumor margin were significantly associated with SR1, and tumor margin was associated with SR2. CONCLUSION SRs in different ROIs in the reference tissue at the same depth showed no different diagnostic value for breast tumor. Both SR1 and SR2 could be useful in assessing the biological characteristics of invasive breast carcinoma.
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Affiliation(s)
- Hui Wang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Cui-Ying Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Hai-Ling Zha
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Di Xu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Zhi-Bin Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People’s Republic of China
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Jia W, Luo T, Dong Y, Zhang X, Zhan W, Zhou J. Breast Elasticity Imaging Techniques: Comparison of Strain Elastography and Shear-Wave Elastography in the Same Population. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:104-113. [PMID: 33109379 DOI: 10.1016/j.ultrasmedbio.2020.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
Our purpose was to compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) in differentiating breast lesions by combining with conventional ultrasound (US). A total of 198 patients with 203 breast lesions underwent conventional US, SE and SWE examination using MyLab 90 and Aixplorer US systems. The SE parameters were SEscore, fat-to-lesion ratio, gland-to-lesion ratio, muscle-to-lesion ratio and SEmean, and the SWE parameters were Emax, Emean, Emin and Esd. Conventional US had the best diagnostic performance, with an area under the curve (AUC) of 0.896. Among all SE parameters, the AUCs of SEscore, fat-to-lesion ratio and SEmean were 0.802, 0.810 and 0.833. For SWE parameters, they were 0.845, 0.746 and 0.845, respectively, for Emax, Emean and Esd. When combined with US, the sensitivity and AUC of SWE seemed to be better than those of SE (96.55% vs. 93.10%, 0.958 vs. 0.947), but no statistically significant difference existed between them.
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Affiliation(s)
- WanRu Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YiJie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - XiaoXiao Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - WeiWei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Vairavan R, Abdullah O, Retnasamy PB, Sauli Z, Shahimin MM, Retnasamy V. A Brief Review on Breast Carcinoma and Deliberation on Current Non Invasive Imaging Techniques for Detection. Curr Med Imaging 2020; 15:85-121. [PMID: 31975658 DOI: 10.2174/1573405613666170912115617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Breast carcinoma is a life threatening disease that accounts for 25.1% of all carcinoma among women worldwide. Early detection of the disease enhances the chance for survival. DISCUSSION This paper presents comprehensive report on breast carcinoma disease and its modalities available for detection and diagnosis, as it delves into the screening and detection modalities with special focus placed on the non-invasive techniques and its recent advancement work done, as well as a proposal on a novel method for the application of early breast carcinoma detection. CONCLUSION This paper aims to serve as a foundation guidance for the reader to attain bird's eye understanding on breast carcinoma disease and its current non-invasive modalities.
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Affiliation(s)
- Rajendaran Vairavan
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
| | - Othman Abdullah
- Hospital Sultan Abdul Halim, 08000 Sg. Petani, Kedah, Malaysia
| | | | - Zaliman Sauli
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
| | - Mukhzeer Mohamad Shahimin
- Department of Electrical and Electronic Engineering, Faculty of Engineering, National Defence University of Malaysia (UPNM), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Vithyacharan Retnasamy
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
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Sezgin G, Coskun M, Apaydin M, Akder Sari A. The role of rare breast cancers in the false negative strain elastography results. Radiol Med 2020; 126:349-355. [PMID: 32894448 DOI: 10.1007/s11547-020-01270-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Elastography was primarily used as an adjunctive method along with ultrasonography in differentiation between benign from malignant lesions. Occasionally, overlaps can occur which are caused by some rare invasive breast cancers. Our aim is to analyze the role of rare breast cancers in false negative strain elastography results and to assess the relation among false negative results and tumor size, lesion distance to skin, and tumor grade. METHODS Patients with BI-RADS 5 category underwent strain elastography and core biopsy. All those with confirmed invasive breast cancer were included. For each rare breast cancer, four usual invasive breast cancer cases were taken as a control group. The cut-off value of strain ratio was considered as 2.3. The true positive and the false negative groups were compared in terms of histological type (rare carcinomas and the others) and the other parameters. Pearson Chi-square and Fisher's exact test were used for statistical analyses. P values < 0.05 were considered statistically significant. RESULTS One hundred-thirteen patients were defined as true positive (70.6%), and 47 patients were defined as false negative (29.4%). Strain ratio values of the rare breast cancers were significantly lower than those of the other breast cancers (p = 0.012). There was no statistically significant difference between the groups with respect to tumor size, distance to skin, and tumor grade (p > 0.05). CONCLUSION The rare breast cancers are an important cause of false negativity in elastographic evaluation of invasive breast cancers. The results should be interpreted in combination with grayscale US findings.
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Affiliation(s)
- Gulten Sezgin
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey.
| | - Mehmet Coskun
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey
| | - Melda Apaydin
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey
| | - Aysegul Akder Sari
- Department of Pathology, Izmir Katip Celebi University Faculty of Medicine, 35150, Izmir, Turkey
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Kim H, Lee J, Kang BJ, Kim SH. What shear wave elastography parameter best differentiates breast cancer and predicts its histologic aggressiveness? Ultrasonography 2020; 40:265-273. [PMID: 32660207 PMCID: PMC7994732 DOI: 10.14366/usg.20007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/15/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose This study aimed to identify useful shear wave elastography (SWE) parameters for differentiating breast cancer and predicting associated immunohistochemical factors and subtypes. Methods From November 2018 to February 2019, a total of 211 breast lesions from 190 patients who underwent conventional breast ultrasonography and SWE were included. The Breast Imaging Reporting and Data System categories and qualitative and quantitative SWE parameters for each lesion were obtained. Pathologic results including immunohistochemical factors were evaluated. The diagnostic performance of each parameter and its correlation with histological characteristics, immunohistochemical factors, and subtypes of breast cancer were analyzed using analysis of variance, the independent t test, the Fisher exact test, logistic regression analysis, and the DeLong method. Results Among 211 breast lesions, 82 were malignant, and 129 were benign. Of the SWE parameters, Emax showed the highest area under the curve (AUC) for differentiating malignant from benign lesions (AUC, 0.891; cut-off>50.85). Poor tumor differentiation and progesterone receptor-negativity were correlated with higher SDmean and Emax (P<0.05). Ki-67-positive breast cancer showed higher SDmean and a heterogeneous color distribution (P<0.05). Ki-67 and cytokeratin 5/6-positive breast cancers showed higher Emax/Efat ratios (P<0.05). Luminal B, human epidermal growth factor receptor 2-enriched, and triple-negative (non-basal) subtypes showed somewhat higher SDmean values than the luminal A and triple-negative (basal) subtypes (P=0.028). Conclusion Emax is a reliable parameter for differentiating malignancies from benign breast lesions. In addition, high stiffness and SDmean values in tumors measured on SWE could be used to predict poorly differentiated, progesterone receptor-negative, or Ki-67-positive breast cancer.
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Affiliation(s)
- Hyunjin Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeongmin Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Relationship Between Shear Wave Elastography Findings and Histologic Prognostic Factors of Invasive Breast Cancer. Ultrasound Q 2020; 36:79-83. [DOI: 10.1097/ruq.0000000000000471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Liu H, Wan J, Xu G, Xiang LH, Fang Y, Ding SS, Jiang X, Sun LP, Zhang YF. Conventional US and 2-D Shear Wave Elastography of Virtual Touch Tissue Imaging Quantification: Correlation with Immunohistochemical Subtypes of Breast Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2612-2622. [PMID: 31371128 DOI: 10.1016/j.ultrasmedbio.2019.06.421] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
Our study aimed to investigate the correlation of the imaging features obtained using conventional ultrasound (US) and elastography (conventional strain elastography of elasticity imaging [EI], virtual touch tissue imaging [VTI] and 2-D shear wave elastography [2-D-SWE] of virtual touch tissue imaging quantification [VTIQ]) with the clinicopathologic features and immunohistochemical (IHC) subtypes of breast cancer. The sample consisted of images from 202 patients with 206 breast lesions that were confirmed as breast cancers. Lesions with HER2 overexpression (luminal B HER2+ or HER2+) had higher mean shear wave velocity (SWV) values than the others. Older patients, lower histologic grade, no lymphovascular invasion and no lymph node metastasis were associated with luminal A (p < 0.001). There were significant differences in SWV values, histologic grade and lymph node status among the different pathologic types. This association may allow the use of 2-D-SWE in the pre-operative prediction of tumor characteristics and biologic activity, which may determine the prognosis in a non-invasive manner.
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Affiliation(s)
- Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Jing Wan
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Yan Fang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Shi-Si Ding
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao Jiang
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
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Liu Y, Huang Y, Han J, Wang J, Li F, Zhou J. Association Between Shear Wave Elastography of Virtual Touch Tissue Imaging Quantification Parameters and the Ki-67 Proliferation Status in Luminal-Type Breast Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:73-80. [PMID: 29708280 DOI: 10.1002/jum.14663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the association between shear wave elastography parameters using virtual touch tissue imaging quantification (VTIQ) and the Ki-67 index in luminal-type breast cancer. METHODS Eighty-one patients with 82 lesions of pathologic confirmed luminal-type breast cancer underwent virtual touch tissue imaging quantification examination before surgery between December 2015 and June 2016. Patients were divided into 2 groups according to the Ki-67 index (≥14% versus < 14%), which is used to define luminal type B and luminal type A, respectively. The mean shear wave velocity (SWVmean ) and lesion-to-adjacent tissues ratio (SWV ratio) were calculated for each lesion. RESULTS The SWVmean , SWV ratio, histologic grade, axillary lymph node involvement, and lymphovascular invasion showed a significant positive association with a high Ki-67 index (all P < .05). Receiver operating characteristic curve analysis for the differential diagnosis between high (≥14%) and low (<14%) Ki-67 groups displayed that the optimal cutoff value for SWVmean and SWV ratio were 3.99 meters per second and 2.861, with sensitivity 94% and 72%, specificity 40.6% and 56.2%, and area under the receiver operating characteristic curve of 0.689 and 0.651, respectively. Univariate analysis showed that SWVmean (P = .005), SWV ratio (P = .029), histologic grade (P = .011), presence of axillary node involvement (P = .004), and lymphovascular invasion (P = .008) were significantly associated with high Ki-67 status. Multivariable analysis displayed that SWVmean (hazard ratio [HR], 1.459, 95% confidence interval [CI], 1.028-2.072; P = .035), histologic grade (HR, 4.105; 95% CI, 1.142-14.763; P = .031), and presence of axillary node involvement (HR, 3.75; 95% CI, 1.228-11.453; P = .020) maintained significance for predicting high Ki-67 status. CONCLUSIONS The SWVmean using the virtual touch tissue imaging quantification method showed significant correlation with the Ki-67 index, suggesting the potential to assess tumor proliferation status in luminal-type breast cancer with a noninvasive manner.
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Affiliation(s)
- Yubo Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Yini Huang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Jing Han
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Jianwei Wang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Fei Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 6, Guangzhou, China
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22
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Wan J, Wu R, Yao M, Xu G, Liu H, Pu H, Xiang L, Zhang S. Acoustic radiation force impulse elastography in evaluation of triple-negative breast cancer: A preliminary experience. Clin Hemorheol Microcirc 2018; 70:301-310. [PMID: 29843225 DOI: 10.3233/ch-170363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jing Wan
- Department of Ultrasound in Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Educational institute, Tongji University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Ultrasound in Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Educational institute, Tongji University School of Medicine, Shanghai, China
| | - Minghua Yao
- Department of Ultrasound in Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Educational institute, Tongji University School of Medicine, Shanghai, China
| | - Guang Xu
- Department of Ultrasound in Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Educational institute, Tongji University School of Medicine, Shanghai, China
| | - Hui Liu
- Department of Ultrasound in Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Educational institute, Tongji University School of Medicine, Shanghai, China
| | - Huan Pu
- Department of Ultrasound in Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Educational institute, Tongji University School of Medicine, Shanghai, China
| | - Lihua Xiang
- Department of Ultrasound in Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Educational institute, Tongji University School of Medicine, Shanghai, China
| | - Shupin Zhang
- Department of Ultrasound in Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Educational institute, Tongji University School of Medicine, Shanghai, China
- Department of Medical Ultrasound, Shanghai First People’s Hospital Baoshan Branch, Shanghai, China
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23
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Song EJ, Sohn YM, Seo M. Tumor stiffness measured by quantitative and qualitative shear wave elastography of breast cancer. Br J Radiol 2018; 91:20170830. [PMID: 29557217 DOI: 10.1259/bjr.20170830] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To correlate clinicoradiologic and pathological features of breast cancer with quantitative and qualitative shear wave elastographic parameters. METHODS 82 breast cancers in 75 patients examined by B-mode ultrasound and shear wave elastography (SWE) were included. SWE parameters including quantitative factors [maximum elasticity (Emax), mean elasticity (Emean), elasticity ratio (Eratio) and standard deviation (SD)] and qualitative factor (color pattern) were correlated with clinicoradiologic and pathological features using univariate and multivariate linear regression analyses. RESULTS Presence of symptoms and larger tumor size on ultrasound were significantly associated with higher Emax, Emean, Eratio, and SD (all p < 0.05) on univariate analysis. Older age was significantly correlated with higher Emax and Emean (p = 0.026, 0.018). Lymphovascular invasion and larger pathologic size were significantly associated with higher Emax (p = 0.036, 0.043) and SD (p < 0.001, 0.019). No immunohistochemical biomarkers were significantly correlated with SWE parameters. There was no significant correlation between color pattern and any variable. Multivariate logistic regression analysis showed that the symptom, tumor size on ultrasound and lymphovascular invasion were independent factors that influenced the SWE values. CONCLUSION Tumor stiffness as measured by SWE and B-mode ultrasound could help predict cancer prognosis. Advances in knowledge: Clinicoradiologic factors had correlation with quantitative and qualitative SWE parameters. Using SWE parameters and B-mode ultrasound, we can predict breast cancer prognosis.
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Affiliation(s)
- Eun Jee Song
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University , Seoul , South Korea
| | - Yu-Mee Sohn
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University , Seoul , South Korea
| | - Mirinae Seo
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University , Seoul , South Korea
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24
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Fei LMD, Bei WMD, Hongyu DMD, Hongjun SMD. Sonographic Features of Triple Negative Breast Cancer. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2018. [DOI: 10.37015/audt.2018.180005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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25
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Kang HJ, Kim JY, Lee NK, Lee JW, Song YS, Park SY, Shin JK. Three-dimensional versus two-dimensional shear-wave elastography: Associations of mean elasticity values with prognostic factors and tumor subtypes of breast cancer. Clin Imaging 2017; 48:79-85. [PMID: 29055275 DOI: 10.1016/j.clinimag.2017.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/02/2017] [Accepted: 10/10/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To explore associations between prognostic factors and subtypes of invasive breast cancer (IBC) and elasticity values using three-dimensional (3D) and two-dimensional (2D) shear-wave elastography (SWE). MATERIALS AND METHODS Mean elasticity values (kPa) of 121 IBCs were measured using both 3D and 2D SWE. Associations between these values and prognostic factors and subtypes were analyzed using linear regression model. RESULTS In both 3D and 2D SWE, larger size and presence of lymphovascular invasion were independent factors influencing higher mean elasticity on multivariate analyses (all p values<0.05). CONCLUSIONS Using either 3D or 2D SWE, higher mean elasticity values are associated with poor prognostic factors of IBC.
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Affiliation(s)
- Hyun Jung Kang
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Jin You Kim
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea; Medical Research Institute, Pusan National University School of Medicine, Busan, Republic of Korea.
| | - Nam Kyung Lee
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - You Seon Song
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Shin Young Park
- Department of Radiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Jong Ki Shin
- Medical Research Institute, Pusan National University School of Medicine, Busan, Republic of Korea
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26
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Seguin J, Mignet N, Latorre Ossa H, Tanter M, Gennisson JL. Evaluation of Antivascular Combretastatin A4 P Efficacy Using Supersonic Shear Imaging Technique of Ectopic Colon Carcinoma CT26. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2352-2361. [PMID: 28666550 DOI: 10.1016/j.ultrasmedbio.2017.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 05/05/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
A recent ultrasound imaging technique-shear wave elastography-showed its ability to image and quantify the mechanical properties of biological tissues, such as prostate or liver tissues. In the present study this technique was used to evaluate the relationship among tumor growth, stiffness and reduction of treatment with combretastatin (CA4 P) in allografted colon tumor CT26 in mice. During 12 d, CT26 tumor growth (n = 52) was imaged by ultrasound, and shear modulus was quantified, showing a good correlation between tumor volume and stiffness (r = 0.59). The treatment was initiated at d 12 and monitored every d during 4 d. Following the treatment, the tumor volume had decreased, while the elasticity of the tumor volume remained steady throughout the treatment. After segmentation using the shear modulus map, a detailed analysis showed a decrease in the stiffness after treatment. This reduction in the mechanical properties was shown to correlate with tissue reorganization, particularly, fibrosis and necrosis, assessed by histology.
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Affiliation(s)
- Johanne Seguin
- Paris Descartes University, Faculty of Pharmacy, Chimie ParisTech, Sorbonne Paris Cité, Chemical and Biological Technologies for Health Laboratory, Paris, France
| | - Nathalie Mignet
- Paris Descartes University, Faculty of Pharmacy, Chimie ParisTech, Sorbonne Paris Cité, Chemical and Biological Technologies for Health Laboratory, Paris, France
| | - Heldmuth Latorre Ossa
- Institut Langevin - Ondes et Images, ESPCI Paris, PSL Research University, Paris, France
| | - Mickaël Tanter
- Institut Langevin - Ondes et Images, ESPCI Paris, PSL Research University, Paris, France
| | - Jean-Luc Gennisson
- Institut Langevin - Ondes et Images, ESPCI Paris, PSL Research University, Paris, France.
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27
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Durhan G, Öztekin PS, Ünverdi H, Değirmenci T, Durhan A, Karakaya J, Nercis Koşar P, Necip Köseoğlu E, Hücümenoğlu S. Do Histopathological Features and Microcalcification Affect the Elasticity of Breast Cancer? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1101-1108. [PMID: 28240797 DOI: 10.7863/ultra.16.06064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate any association between histological grade, molecular subtypes of breast cancer, and strain elastography, and to investigate whether microcalcification affects the stiffness of tumor in breast cancers with the same histological grade. METHODS Between April 2015 and March 2016, 94 lesions of 94 patients with the diagnosis of invasive ductal carcinoma were included in the study. Strain elastography was performed on all patients before biopsy. Histological grades (Grades 1, 2, and 3), molecular subtypes (luminal A, luminal B, Her-2, and basal-like), and strain ratio (SR) were compared. In the same histological grades, patients were divided into two groups according to the presence of microcalcifications, and the groups were compared with each other. RESULTS Compared with Grades 1 (20.5) and 2 (23.7), Grade 3 (11.7) showed lower SR values (Grade 3-2, P = .01; Grade 3-1, P = .2). The groups with microcalcification had slightly higher SR in all histological grades, but not of statistical significance. In molecular subtypes, luminal A and B demonstrated higher SR, whereas HER2 and basal-like had lower SR (P > .05 for all group comparisons). CONCLUSIONS Grade 3 invasive ductal carcinomas are different from other grades with lower SR values. The presence of microcalcifications and molecular subtypes do not affect elasticity like a high histological grade does.
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Affiliation(s)
- Gamze Durhan
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Pelin Seher Öztekin
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Hatice Ünverdi
- Department of Pathology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Tülin Değirmenci
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Abdullah Durhan
- Department of General Surgery, Surgical Oncology Unit, Ankara University Medical School, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Medical School, Ankara, Turkey
| | - Pınar Nercis Koşar
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Enver Necip Köseoğlu
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
| | - Sema Hücümenoğlu
- Department of Pathology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey
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28
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Chen YP, Han T, Wu R, Yao MH, Xu G, Zhao LX, Liu H, Pu H, Fang Y. Comparison of Virtual Touch Tissue Quantification and Virtual Touch Tissue Imaging Quantification for diagnosis of solid breast tumors of different sizes. Clin Hemorheol Microcirc 2017; 64:235-244. [PMID: 27814284 DOI: 10.3233/ch-16192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acoustic radiation force impulse imaging (ARFI) with Virtual Touch Tissue Quantification (VTQ) or Virtual Touch Tissue Imaging Quantification (VTIQ) measures shear wave velocity (SWV), which is proportional to tissue stiffness, a diagnostic parameter for malignancy. OBJECTIVE To compare the performance of VTQ and VTIQ in diagnosing solid breast tumors. METHODS Conventional ultrasound, VTQ and VTIQ were used to examine 246 solid breast tumors from 230 patients. Tumors were grouped according to size: <10 mm, 10-20 mm, >20 mm. Pathological diagnoses were via histological examination of biopsies. ROC curves were used to assess diagnostic performance and optimal cut-off points for VTQ and VTIQ. RESULTS For all sizes, SWVVTQ and SWVVTIQ were higher for malignant versus benign tumors (P < 0.05). SWVVTQ and SWVVTIQ were both higher for tumors≥10 mm (P < 0.05). Areas under the ROC curves (diagnostic performance index; 0.860-0.952) did not differ significantly between VTQ and VTIQ. Optimal cut-off values for SWVVTQ and SWVVTIQ were higher for tumors≥10 mm. CONCLUSION The diagnostic performance of VTQ and VTIQ was moderate to good for solid breast tumors. Although both methods have higher sensitivities in tumors≥10 mm, their overall diagnostic performance was similar for all sizes.
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Affiliation(s)
- Ying-Pei Chen
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Department of Medical Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Changle Road, Shanghai, China
| | - Ting Han
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China
| | - Ming-Hua Yao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China
| | - Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China
| | - Li-Xia Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China
| | - Hui Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China
| | - Huan Pu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China
| | - Yan Fang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China.,Ultrasound Research and Education Institute, Tongji University School of Medicine, Yanchangzhong Road, Shanghai, China
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29
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Cong R, Li J, Guo S. A new qualitative pattern classification of shear wave elastograghy for solid breast mass evaluation. Eur J Radiol 2017; 87:111-119. [DOI: 10.1016/j.ejrad.2016.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/13/2016] [Accepted: 12/19/2016] [Indexed: 12/21/2022]
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30
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Denis M, Gregory A, Bayat M, Fazzio RT, Whaley DH, Ghosh K, Shah S, Fatemi M, Alizad A. Correlating Tumor Stiffness with Immunohistochemical Subtypes of Breast Cancers: Prognostic Value of Comb-Push Ultrasound Shear Elastography for Differentiating Luminal Subtypes. PLoS One 2016; 11:e0165003. [PMID: 27776153 PMCID: PMC5077080 DOI: 10.1371/journal.pone.0165003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/04/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of our study is to correlate quantitatively measured tumor stiffness with immunohistochemical (IHC) subtypes of breast cancer. Additionally, the influence of prognostic histologic features (cancer grade, size, lymph node status, and histological type and grade) to the tumor elasticity and IHC profile relationship will be investigated. METHODS Under an institutional review board (IRB) approved protocol, B-mode ultrasound (US) and comb-push ultrasound shear elastography (CUSE) were performed on 157 female patients with suspicious breast lesions. Out of 157 patients 83 breast cancer patients confirmed by pathology were included in this study. The association between CUSE mean stiffness values and the aforementioned prognostic features of the breast cancer tumors were investigated. RESULTS Our results demonstrate that the most statistically significant difference (p = 0.0074) with mean elasticity is tumor size. When considering large tumors (size ≥ 8mm), thus minimizing the statistical significance of tumor size, a significant difference (p< 0.05) with mean elasticity is obtained between luminal A of histological grade I and luminal B (Ki-67 > 20%) subtypes. CONCLUSION Tumor size is an independent factor influencing mean elasticity. The Ki-67 proliferation index and histological grade were dependent factors influencing mean elasticity for the differentiation between luminal subtypes. Future studies on a larger group of patients may broaden the clinical significance of these findings.
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Affiliation(s)
- Max Denis
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Adriana Gregory
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Mahdi Bayat
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Dana H Whaley
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Karthik Ghosh
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, 55905, United States of America
| | - Sejal Shah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America
| | - Azra Alizad
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, United States of America.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, United States of America.,Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, 55905, United States of America
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31
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Song JL, Chen C, Yuan JP, Sun SR. Progress in the clinical detection of heterogeneity in breast cancer. Cancer Med 2016; 5:3475-3488. [PMID: 27774765 PMCID: PMC5224851 DOI: 10.1002/cam4.943] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 12/18/2022] Open
Abstract
Breast cancer is currently the most common form of cancer and the second‐leading cause of death from cancer in women. Though considerable progress has been made in the treatment of breast cancer, the heterogeneity of tumors (both inter‐ and intratumor) remains a considerable diagnostic and prognostic challenge. From clinical observation to genetic mutations, the history of understanding the heterogeneity of breast cancer is lengthy and detailed. Effectively detecting heterogeneity in breast cancer is important during treatment. Various methods of depicting this heterogeneity are now available and include genetic, pathologic, and imaging analysis. These methods allow characterization of the heterogeneity of breast cancer on a genetic level, providing greater insight during the process of establishing an effective therapeutic plan. This study reviews how the understanding of tumor heterogeneity in breast cancer evolved, and further summarizes recent advances in the detection and monitoring of this heterogeneity in patients with breast cancer.
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Affiliation(s)
- Jun-Long Song
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Jing-Ping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
| | - Sheng-Rong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China
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32
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Cho N. Molecular subtypes and imaging phenotypes of breast cancer. Ultrasonography 2016; 35:281-8. [PMID: 27599892 PMCID: PMC5040136 DOI: 10.14366/usg.16030] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023] Open
Abstract
During the last 15 years, traditional breast cancer classifications based on histopathology have been reorganized into the luminal A, luminal B, human epidermal growth factor receptor 2 (HER2), and basal-like subtypes based on gene expression profiling. Each molecular subtype has shown varying risk for progression, response to treatment, and survival outcomes. Research linking the imaging phenotype with the molecular subtype has revealed that non-calcified, relatively circumscribed masses with posterior acoustic enhancement are common in the basal-like subtype, spiculated masses with a poorly circumscribed margin and posterior acoustic shadowing in the luminal subtype, and pleomorphic calcifications in the HER2-enriched subtype. Understanding the clinical implications of the molecular subtypes and imaging phenotypes could help radiologists guide precision medicine, tailoring medical treatment to patients and their tumor characteristics.
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Affiliation(s)
- Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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33
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Li Z, Tian J, Wang X, Wang Y, Wang Z, Zhang L, Jing H, Wu T. Differences in Multi-Modal Ultrasound Imaging between Triple Negative and Non-Triple Negative Breast Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:882-890. [PMID: 26786891 DOI: 10.1016/j.ultrasmedbio.2015.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Abstract
The objective of this study was to identify multi-modal ultrasound imaging parameters that could potentially help to differentiate between triple negative breast cancer (TNBC) and non-TNBC. Conventional ultrasonography, ultrasound strain elastography and 3-D ultrasound (3-D-US) findings from 50 TNBC and 179 non-TNBC patients were retrospectively reviewed. Immunohistochemical examination was used as the reference gold standard for cancer subtyping. Different ultrasound modalities were initially analyzed to define TNBC-related features. Subsequently, logistic regression analysis was applied to TNBC-related features to establish models for predicting TNBC. TNBCs often presented as micro-lobulated, markedly hypo-echoic masses with an abrupt interface (p = 0.015, 0.0015 and 0.004, compared with non-TNBCs, respectively) on conventional ultrasound, and showed a diminished retraction pattern phenomenon in the coronal plane (p = 0.035) on 3-D-US. Our findings suggest that B-mode ultrasound and 3-D-US in multi-modality ultrasonography could be a useful non-invasive technique for differentiating TNBCs from non-TNBCs.
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Affiliation(s)
- Ziyao Li
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiawei Tian
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Xiaowei Wang
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Wang
- Department of General Surgery, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenzhen Wang
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Zhang
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Jing
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tong Wu
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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