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Wan C, Zhou L, Jin Y, Li F, Wang L, Yin W, Wang Y, Li H, Jiang L, Lu J. Strain ultrasonic elastography imaging features of locally advanced breast cancer: association with response to neoadjuvant chemotherapy and recurrence-free survival. BMC Med Imaging 2023; 23:216. [PMID: 38129778 PMCID: PMC10734101 DOI: 10.1186/s12880-023-01168-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Due to the highly heterogeneity of the breast cancer, it would be desirable to obtain a non-invasive method to early predict the treatment response and survival outcome of the locally advanced breast cancer (LABC) patients undergoing neoadjuvant chemotherapy (NAC). This study aimed at investigating whether strain elastography (SE) can early predict the pathologic complete response (pCR) and recurrence-free survival (RFS) in LABC patients receiving NAC. METHODS In this single-center retrospective study, 122 consecutive women with LABC who underwent SE examination pre-NAC and after one and two cycles of NAC enrolled in the SHPD001(NCT02199418) and SHPD002 (NCT02221999) trials between January 2014 and August 2017 were included. The SE parameters (Elasticity score, ES; Strain ratio, SR; Hardness percentage, HP, and Area ratio, AR) before and during NAC were assessed. The relative changes in SE parameters after one and two cycles of NAC were describe as ΔA1 and ΔA2, respectively. Logistic regression analysis and Cox proportional hazards model were used to identify independent variables associated with pCR and RFS. RESULTS Forty-nine (40.2%) of the 122 patients experienced pCR. After 2 cycles of NAC, SR2 (odds ratio [OR], 1.502; P = 0.003) and ΔSR2 (OR, 0.013; P = 0.015) were independently associated with pCR, and the area under the receiver operating characteristic curve for the combination of them to predict pCR was 0.855 (95%CI: 0.779, 0.912). Eighteen (14.8%) recurrences developed at a median follow-up of 60.7 months. A higher clinical T stage (hazard ratio [HR] = 4.165; P = 0.005.), a higher SR (HR = 1.114; P = 0.002.) and AR (HR = 1.064; P < 0.001.) values at pre-NAC SE imaging were independently associated with poorer RFS. CONCLUSION SE imaging features have the potential to early predict pCR and RFS in LABC patients undergoing NAC, and then may offer valuable predictive information to guide personalized treatment.
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Affiliation(s)
- Caifeng Wan
- Department of Breast Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China
| | - Liheng Zhou
- Department of Breast Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China
| | - Ye Jin
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China
| | - Fenghua Li
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China
| | - Lin Wang
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China
| | - Wenjin Yin
- Department of Breast Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China
| | - Yaohui Wang
- Department of Breast Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China
| | - Hongli Li
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China.
| | - Lixin Jiang
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China.
| | - Jinsong Lu
- Department of Breast Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pujian Rd, Shanghai, 200127, China.
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Sefidbakht S, Haseli S, Khalili N, Bazojoo V, Keshavarz P, Zeinali-Rafsanjani B. Can shear wave elastography be utilized as an additional tool for the assessment of non-mass breast lesions? ULTRASOUND (LEEDS, ENGLAND) 2022; 30:44-51. [PMID: 35173778 PMCID: PMC8841944 DOI: 10.1177/1742271x21998721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/06/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION We aimed to describe shear wave elastography parameters of non-mass lesions of the breast and to assess the measures of diagnostic accuracy of shear wave elastography in the differentiation of non-mass lesions compared with conventional ultrasound, using histopathologic results as the reference standard. METHODS This retrospective study included breast ultrasound-detected non-mass lesions with a confirmed pathologic diagnosis during a two-year study period. B-mode ultrasound and shear wave elastography were performed for all lesions before biopsy. Ultrasound features, shear wave elastography parameters (mean elasticity and maximum stiffness color), as well as Breast Imaging-Reporting and Data System categories were recorded for each lesion. Measures of diagnostic accuracy of ultrasound and ultrasound + shear wave elastography were also assessed. RESULTS From a total of 567 breast lesions requiring core-needle biopsy, 49 (8.6%) were considered as non-mass lesions. Based on histopathologic reports, 32 patients (65.3%) had non-high-risk benign lesions, five (10.2%) had high-risk benign lesions, five (10.2%) had ductal carcinoma in situ, and seven (14.3%) had invasive carcinoma. There was no significant difference in patients' age and palpability between benign and malignant lesions (p = 0.16 and p = 0.12, respectively). Mean elasticity values and Breast Imaging-Reporting and Data System categories were significantly higher among malignant lesions compared with benign non-mass lesions (both p < 0.001). Furthermore, the addition of shear wave elastography to grayscale ultrasound increased the specificity, positive predictive value, and diagnostic accuracy. CONCLUSION The complementary use of shear wave elastography with conventional ultrasound might help in the differentiation of non-mass breast lesions and has the potential to decrease the frequency of unnecessary biopsies performed for benign non-mass lesions.
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Affiliation(s)
- Sepideh Sefidbakht
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Haseli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,Sara Haseli, Shahid Beheshti University of Medical Sciences, Tehran 19839-6311, Iran.
| | - Neda Khalili
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Bazojoo
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Keshavarz
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kim JY, Kim JJ, Hwangbo L, Suh HB, Lee JW, Lee NK, Choo KS, Kim S. Tumor stiffness measured by shear-wave elastography: association with disease-free survival in women with early-stage breast cancer. Br J Radiol 2021; 94:20210584. [PMID: 34558307 DOI: 10.1259/bjr.20210584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether shear-wave elastography (SWE)-measured tumor stiffness is associated with disease-free survival in females with early-stage invasive breast cancer. METHODS This retrospective study included 202 consecutive females (mean age, 52.9 years; range, 25-84 years) with newly diagnosed T1-two breast cancer who underwent preoperative SWE between April 2015 and January 2016. Tumor stiffness was assessed and quantitative SWE features of each breast lesion were obtained by a breast radiologist. Cox proportional hazard models were used to identify associations between SWE features and disease-free survival after adjusting for clinicopathologic factors. RESULTS Fifteen (7.4%) patients exhibited recurrence after a median follow-up of 56 months. Mean (Emean), minimum, and maximum elasticity values were higher in females with recurrence than in those without recurrence (184.4, 138.3, and 210.5 kPa vs 134.9, 101.7, and 159.8 kPa, respectively; p = 0.005, p = 0.005, and p = 0.012, respectively). Receiver operating characteristics curve analysis for prediction of recurrence showed that Emean yielded the largest area under the curve (0.717) among the quantitative SWE parameters, and the optimal cut-off value was 121.7 kPa. Multivariable Cox proportional hazards analysis revealed that higher Emean (>121.7 kPa) [adjusted hazard ratio (HR), 10.01; 95% CI: 1.31-76.33; p = 0.026] and lymphovascular invasion (adjusted HR, 7.72; 95% CI: 1.74-34.26; p = 0.007) were associated with worse disease-free survival outcomes. CONCLUSION Higher SWE-measured Emean was associated with worse disease-free survival in females with early-stage invasive breast cancer. ADVANCES IN KNOWLEDGE Tumor stiffness assessed with shear-wave elastography might serve as a quantitative imaging biomarker of disease-free survival in females with T1-two breast cancer.
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Affiliation(s)
- Jin You Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Jin Joo Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Lee Hwangbo
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Hie Bum Suh
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Ji Won Lee
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Nam Kyung Lee
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Suk Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
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Hao Y, Yang W, Zheng W, Chen X, Wang H, Zhao L, Xu J, Guo X. Tumor elastography and its association with cell-free tumor DNA in the plasma of breast tumor patients: a pilot study. Quant Imaging Med Surg 2021; 11:3518-3534. [PMID: 34341728 DOI: 10.21037/qims-20-443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
Background Breast tumor stiffness, which can be objectively and noninvasively evaluated by ultrasound elastography (UE), has been useful for the differentiation of benign and malignant breast lesions and the prediction of clinical outcomes. Liquid biopsy analyses, including cell-free tumor DNA (ctDNA), exhibit great potential for personalized treatment. This study aimed to investigate the correlations between the UE and ctDNA for early breast cancer diagnosis. Methods Breast tumor stiffness in 10 patients were assessed by shear wave elastography (SWE), and the ctDNA of eight collected plasma specimens with different tumor stiffness were analyzed by whole-genome sequencing (WGS). Subsequently, the distribution of carcinoma-associated fibroblasts (CAFs) was investigated by detecting the expression levels of alpha-smooth muscle actin (α-SMA) in tissues of breast lesions. We validated the function of discoidin domain receptor 2 (DDR2) in breast tumor CAFs by knockout of fibroblast activation protein (FAP) with different tumor stiffness during cancer progression in vitro and vivo. Results The UE estimates of tumor stiffness positively correlated with CAF-rich (α-SMA+) tumors (P<0.05). Copy number profiles and percent genome alterations were remarkably different between benign and malignant breast lesions. Somatic genomic alterations or structural variants of DDR2, ANTXRL, TPSG1, and TPSB2 genes were identified in ctDNA of plasma from breast lesions with high SWE values and an increase in the CAF content obtained from clinical samples. Deletion of FAP in breast tumor CAFs by CRISPR/Cas9-mediated gene knockout and decreased tumor stiffness resulted in downregulated expression of DDR2 (P<0.05), which in turn led to decreasing the tumor stiffness and carcinogenesis process in vitro and in vivo. Conclusions These results have established proof of principle that WGS analysis of ctDNA could complement current UE approaches to assess tumor stiffness changes for the early diagnosis and prognostic assessment of breast cancer.
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Affiliation(s)
- Yi Hao
- Department of Ultrasound, South China Hospital of Shenzhen University, Shenzhen, China
| | - Wei Yang
- Department of Ultrasound, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenyi Zheng
- Department of Ultrasound, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaona Chen
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Shenzhen Key Laboratory of Viral Oncology, Center for Clinical Research and Innovation (CCRI), Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Hui Wang
- Department of Ultrasound, South China Hospital of Shenzhen University, Shenzhen, China.,Department of Ultrasound, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Liang Zhao
- Department of Ultrasound, South China Hospital of Shenzhen University, Shenzhen, China.,Department of Ultrasound, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Xia Guo
- Shenzhen Key Laboratory of Viral Oncology, Center for Clinical Research and Innovation (CCRI), Shenzhen Hospital, Southern Medical University, Shenzhen, 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: 4] [Impact Index Per Article: 1.3] [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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