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Ko KH, Jung HK, Park AY, Koh JE, Jang H, Kim Y. Accuracy of tumor size measurement on shear wave elastography (SWE): Correlation with histopathologic factors of invasive breast cancer. Medicine (Baltimore) 2020; 99:e23023. [PMID: 33126387 PMCID: PMC7598781 DOI: 10.1097/md.0000000000023023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to investigate the accuracy of tumor size assessment by shear wave elastography (SWE) in invasive breast cancer and also evaluated histopathologic factors influencing the accuracy.A total of 102 lesions of 102 women with breast cancers of which the size was 3 cm or smaller were included and retrospectively analyzed. Tumor size on B-mode ultrasound (US) and SWE were recorded and compared with the pathologic tumor size. If tumor size measurements compared to pathological size were within ±3 mm, they were considered as accurate. The relationship between the accuracy and histopathologic characteristics were evaluated.The mean pathologic tumor size was 16.60 ± 6.12 mm. Tumor sizes on SWE were significantly different from pathologic sizes (18.00 ± 6.71 mm, P < 0.001). The accuracy of SWE (69.6%) was lower than that by B-mode US (74.5%). There was more size overestimation than underestimation (23.5% vs 6.9%) using SWE. Conversely, there was more size underestimation than overestimation (18.6% vs 6.9%) using B-mode US. The accuracy of SWE was associated with ER positivity (P = .004), PR positivity (P = .02), molecular subtype (P = .02), and histologic grade (P = .03). In the multivariate analysis, ER positivity (P = .002) and molecular subtype (P = .027) significantly influenced the accuracy of tumor size measurement by SWE.In conclusion, the accuracy of the tumor size measured with SWE was lower than that measured with B-mode US and SWE tends to overestimate the size. ER positivity and molecular subtype are significantly associated with the accuracy of SWE in tumor size assessment.
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Comment optimiser le bilan préopératoire d’un cancer du sein éligible à un traitement oncoplastique ? IMAGERIE DE LA FEMME 2019. [DOI: 10.1016/j.femme.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vijayaraghavan GR, Vedantham S, Santos-Nunez G, Hultman R. Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology. Clin Breast Cancer 2018; 18:e1367-e1372. [PMID: 30131246 DOI: 10.1016/j.clbc.2018.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND We systematically analyzed the extent of disease in unifocal invasive lobular carcinoma (ILC) using ultrasonography, with the histopathologic findings as the reference standard. PATIENTS AND METHODS In the present single-institution retrospective study, 128 cases of ILC were identified during a 5-year period. After exclusions, the analyzed cohort included 66 cases. Ultrasound measurements of the tumor extent along 3 axes were obtained. The tumor size was determined as the largest extent among the 3 axes and the tumor volume by ellipsoidal approximation. Pathology review provided the tumor size and volume. Correlation and regression analyses of tumor size and volume from the ultrasound and pathologic examinations were performed. The tumor stage from the ultrasound and pathologic examinations were used for the concordance analyses. RESULTS The median and quartiles (Q1, Q3) of tumor size from ultrasonography and pathology were 12.5 mm (Q1, 9 mm; Q3, 19 mm) and 17 mm (Q1, 12 mm; Q3, 25 mm), respectively. The corresponding data for tumor volume were 0.52 cm3 (Q1, 0.18 cm3; Q3, 1.92 cm3) and 1.04 cm3 (Q1, 0.45 cm3; Q3, 2.49 cm3). The ultrasound measurements correlated with the pathology-reported tumor size (Spearman ρ = 0.678; P < .0001) and volume (Spearman ρ = 0.699; P < .0001). The ultrasound-measured size and volume differed from the pathology-reported size and volume (P < .0001; Wilcoxon signed ranks test). Concordance between the clinical tumor size stage from ultrasound (cT) and pathology tumor size stage (pT) varied with the pT stage (P = .0003, Fisher's exact test), with the greatest concordance rate of 95.7% (95% confidence limit, 85.2%-99.5%) observed for pT1 tumors. CONCLUSION Ultrasonography underestimates the tumor size and volume, with the underestimation increasing for larger tumors. Hence, the concordance rate in tumor size stage between ultrasonography and pathology is tumor size dependent, with the greatest concordance rate observed for pT1 tumors.
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Streng M, Ignatov A, Reinisch M, Costa SD, Eggemann H. A comparison of tumour size measurements with palpation, ultrasound and mammography in male breast cancer: first results of the prospective register study. J Cancer Res Clin Oncol 2017; 144:381-387. [PMID: 29204896 DOI: 10.1007/s00432-017-2554-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Precise presurgical diagnosis of tumour size is essential for adequate treatment of male breast cancer (MBC). This study is aimed to compare the accuracy of clinical measurement (CE), ultrasound (US) and mammography (MG) for preoperative estimation of tumour size. METHODS This study was conducted as a prospective, multicentre register study. One hundred and twenty-nine male patients with invasive breast cancer were included. CE, US and MG were performed in 107, 110 and 75 patients, respectively, and the estimated tumour size was compared with the histopathological (HP) tumour size. RESULTS All methods tended to underestimate the HP tumour size. None of the methods were significantly more accurate than the others in determining the maximal tumour diameter. The sensitivity within 5 mm tolerance for US was 65.5%, which was better than for MG (61.3%) and CE (56.6%). In the group of patients with pT2 tumours, MG showed significantly better accuracy than US. The measurements obtained with each method were significantly correlated with the HP measurements. The highest correlation coefficient was observed for MG (0.788), followed by US (0.741) and CE (0.671). CONCLUSIONS Our data demonstrate that MG and US have similar accuracy with regard to tumour size estimation. US assessment showed the highest sensitivity in determining tumour size, followed by MG and CE. However, MG demonstrated a significant advantage for estimating the real tumour size for pT2 tumours compared to US or CE.
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Affiliation(s)
- Martin Streng
- Department of Obstetrics and Gynecology, University of Magdeburg, Magdeburg, Germany
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, University of Magdeburg, Magdeburg, Germany
| | | | - Serban-Dan Costa
- Department of Obstetrics and Gynecology, University of Magdeburg, Magdeburg, Germany
| | - Holm Eggemann
- Department of Obstetrics and Gynecology, University of Magdeburg, Magdeburg, Germany.
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Saldova R, Haakensen VD, Rødland E, Walsh I, Stöckmann H, Engebraaten O, Børresen-Dale AL, Rudd PM. Serum N-glycome alterations in breast cancer during multimodal treatment and follow-up. Mol Oncol 2017; 11:1361-1379. [PMID: 28657165 PMCID: PMC5623820 DOI: 10.1002/1878-0261.12105] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/09/2022] Open
Abstract
Using our recently developed high-throughput automated platform, N-glycans from all serum glycoproteins from patients with breast cancer were analysed at diagnosis, after neoadjuvant chemotherapy, surgery, radiotherapy and up to 3 years after surgery. Surprisingly, alterations in the serum N-glycome after chemotherapy were pro-inflammatory with an increase in glycan structures associated with cancer. Surgery, on the other hand, induced anti-inflammatory changes in the serum N-glycome, towards a noncancerous phenotype. At the time of first follow-up, glycosylation in patients with affected lymph nodes changed towards a malignant phenotype. C-reactive protein showed a different pattern, increasing after first line of neoadjuvant chemotherapy, then decreasing throughout treatment until 1 year after surgery. This may reflect a switch from acute to chronic inflammation, where chronic inflammation is reflected in the serum after the acute phase response subsides. In conclusion, we here present the first time-course serum N-glycome profiling of patients with breast cancer during and after treatment. We identify significant glycosylation changes with chemotherapy, surgery and follow-up, reflecting the host response to therapy and tumour removal.
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Affiliation(s)
- Radka Saldova
- NIBRT GlycoScience Group, National Institute for Bioprocessing Research and Training, Dublin, Ireland
| | - Vilde D Haakensen
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Norway
| | - Einar Rødland
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Norway
| | - Ian Walsh
- Bioprocessing Technology Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Henning Stöckmann
- NIBRT GlycoScience Group, National Institute for Bioprocessing Research and Training, Dublin, Ireland
| | - Olav Engebraaten
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Norway.,Department of Oncology, Oslo University Hospital, Norway
| | - Anne-Lise Børresen-Dale
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Norway.,Institute for Clinical Medicine, University of Oslo, Norway
| | - Pauline M Rudd
- NIBRT GlycoScience Group, National Institute for Bioprocessing Research and Training, Dublin, Ireland
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Stein RG, Wollschläger D, Kreienberg R, Janni W, Wischnewsky M, Diessner J, Stüber T, Bartmann C, Krockenberger M, Wischhusen J, Wöckel A, Blettner M, Schwentner L. The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients. BMC Cancer 2016; 16:459. [PMID: 27411945 PMCID: PMC4943017 DOI: 10.1186/s12885-016-2426-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mammography and ultrasound are the gold standard imaging techniques for preoperative assessment and for monitoring the efficacy of neoadjuvant chemotherapy in breast cancer. Maximum accuracy in predicting pathological tumor size non-invasively is critical for individualized therapy and surgical planning. We therefore aimed to assess the accuracy of tumor size measurement by ultrasound and mammography in a multicentered health services research study. METHODS We retrospectively analyzed data from 6543 patients with unifocal, unilateral primary breast cancer. The maximum tumor diameter was measured by ultrasound and/or mammographic imaging. All measurements were compared to final tumor diameter determined by postoperative histopathological examination. We compared the precision of each imaging method across different patient subgroups as well as the method-specific accuracy in each patient subgroup. RESULTS Overall, the correlation with histology was 0.61 for mammography and 0.60 for ultrasound. Both correlations were higher in pT2 cancers than in pT1 and pT3. Ultrasound as well as mammography revealed a significantly higher correlation with histology in invasive ductal compared to lobular cancers (p < 0.01). For invasive lobular cancers, the mammography showed better correlation with histology than ultrasound (p = 0.01), whereas there was no such advantage for invasive ductal cancers. Ultrasound was significantly superior for HR negative cancers (p < 0.001). HER2/neu positive cancers were also more precisely assessed by ultrasound (p < 0.001). The size of HER2/neu negative cancers could be more accurately predicted by mammography (p < 0.001). CONCLUSION This multicentered health services research approach demonstrates that predicting tumor size by mammography and ultrasound provides accurate results. Biological tumor features do, however, affect the diagnostic precision.
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Affiliation(s)
- Roland Gregor Stein
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
| | - Daniel Wollschläger
- Insititute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz University Hospital, Mainz, Germany
| | - Rolf Kreienberg
- Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany
| | | | - Joachim Diessner
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Tanja Stüber
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Catharina Bartmann
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Mathias Krockenberger
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Jörg Wischhusen
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Maria Blettner
- Insititute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz University Hospital, Mainz, Germany
| | - Lukas Schwentner
- Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany
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Should the hyperechogenic halo around malignant breast lesions be included in the measurement of tumor size? Breast Cancer Res Treat 2016; 156:311-7. [DOI: 10.1007/s10549-016-3758-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 11/25/2022]
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Shiryazdi SM, Kargar S, Taheri-Nasaj H, Neamatzadeh H. BreastLight Apparatus Performance in Detection of Breast Masses Depends on Mass Size. Asian Pac J Cancer Prev 2015; 16:1181-4. [DOI: 10.7314/apjcp.2015.16.3.1181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zippel D, Shalmon A, Rundstein A, Novikov I, Yosepovich A, Zbar A, Goitein D, Sklair-Levy M. Freehand elastography for determination of breast cancer size: comparison with B-mode sonography and histopathologic measurement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1441-1446. [PMID: 25063409 DOI: 10.7863/ultra.33.8.1441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Elastography assesses the strain of soft tissues and is used to enhance diagnostic accuracy in evaluating breast tumors, but minimal data exist on its ability to accurately assess tumor size. This study was performed to assess the preoperative accuracy of measuring the size of biopsyproven breast cancer lesions with elastography and conventional B-mode sonography compared with the reference standard size measured by histopathologic examination. METHODS Elastography and conventional B-mode sonography were performed on 69 women with histologically proven breast cancer, and tumor sizes on both modalities were recorded. These measurements were compared with the final pathologic size, which was used as the reference standard. The sizes and differences between sonographic, elastographic, and pathologic measurements were statistically tested, and an analysis of equivalence to the reference standard was performed using Bland-Altman plots. RESULTS There was a significant difference between sizes on elastography and pathologic examination, with elastography overestimating the tumor size (P = .0187). Sonography slightly underestimated the tumor size, but this finding was not significant (P = .36). Bland-Altman plots confirmed that sonography but not elastography was an acceptable standard compared with the pathologic size. CONCLUSIONS Breast elastography but not B-mode sonography overestimates the size of breast tumors compared with the final pathologic size.
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Affiliation(s)
- Douglas Zippel
- Meirav Breast Health Center (D.Z., A.S., A.R., M.S.-L.), Departments of Diagnostic Imaging (A.S., A.R., M.S.-L.), Pathology (A.Y.), and Surgery C (D.Z., A.Z., D.G.), and Biostatistics Unit, Gertner Institute (I.N.), Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Anat Shalmon
- Meirav Breast Health Center (D.Z., A.S., A.R., M.S.-L.), Departments of Diagnostic Imaging (A.S., A.R., M.S.-L.), Pathology (A.Y.), and Surgery C (D.Z., A.Z., D.G.), and Biostatistics Unit, Gertner Institute (I.N.), Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Arie Rundstein
- Meirav Breast Health Center (D.Z., A.S., A.R., M.S.-L.), Departments of Diagnostic Imaging (A.S., A.R., M.S.-L.), Pathology (A.Y.), and Surgery C (D.Z., A.Z., D.G.), and Biostatistics Unit, Gertner Institute (I.N.), Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ilya Novikov
- Meirav Breast Health Center (D.Z., A.S., A.R., M.S.-L.), Departments of Diagnostic Imaging (A.S., A.R., M.S.-L.), Pathology (A.Y.), and Surgery C (D.Z., A.Z., D.G.), and Biostatistics Unit, Gertner Institute (I.N.), Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ady Yosepovich
- Meirav Breast Health Center (D.Z., A.S., A.R., M.S.-L.), Departments of Diagnostic Imaging (A.S., A.R., M.S.-L.), Pathology (A.Y.), and Surgery C (D.Z., A.Z., D.G.), and Biostatistics Unit, Gertner Institute (I.N.), Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Andrew Zbar
- Meirav Breast Health Center (D.Z., A.S., A.R., M.S.-L.), Departments of Diagnostic Imaging (A.S., A.R., M.S.-L.), Pathology (A.Y.), and Surgery C (D.Z., A.Z., D.G.), and Biostatistics Unit, Gertner Institute (I.N.), Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - David Goitein
- Meirav Breast Health Center (D.Z., A.S., A.R., M.S.-L.), Departments of Diagnostic Imaging (A.S., A.R., M.S.-L.), Pathology (A.Y.), and Surgery C (D.Z., A.Z., D.G.), and Biostatistics Unit, Gertner Institute (I.N.), Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Miri Sklair-Levy
- Meirav Breast Health Center (D.Z., A.S., A.R., M.S.-L.), Departments of Diagnostic Imaging (A.S., A.R., M.S.-L.), Pathology (A.Y.), and Surgery C (D.Z., A.Z., D.G.), and Biostatistics Unit, Gertner Institute (I.N.), Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Wasson J, Amonoo-Kuofi K, Scrivens J, Pfleiderer A. Caliper measurement to improve clinical assessment of palpable neck lumps. Ann R Coll Surg Engl 2012; 94:256-60. [PMID: 22613304 PMCID: PMC3957505 DOI: 10.1308/003588412x13171221499784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION One-stop neck lump clinics with ultrasonography and cytopathology support are an expensive and finite resource. Consequently, many neck lump patients are assessed in general ear, nose and throat or head and neck clinics. Optimal clinical assessment of neck lump size is important to guide investigation, monitor change and provisionally stage nodal disease. The aims of this study were to investigate whether caliper measurement is more accurate than clinical palpation in assessing neck lump size and whether caliper measurement of neck lump size correlates closely with accurate ultrasonography measurement. METHODS A prospective study was carried out involving 50 patients with clinically palpable neck lumps presenting to the one-stop neck lump clinic. Long and short axis neck lump dimensions were estimated first by clinical palpation and second by caliper measurement. Estimations were compared with accurate ultrasonography measurement. RESULTS The mean combined long and short axis measurement deviation from accurate ultrasonography measurement was smaller for caliper measurement (7.80 mm) than for clinical palpation (12.38 mm) (p <0.01). There was no significant difference observed between combined axis ultrasonography and combined axis caliper measurement of neck lumps (p = 0.462). CONCLUSIONS Caliper measurement is more accurate than clinical palpation in estimating the size of clinically palpable neck lumps. The use of calipers to measure the skin surface dimensions of palpable neck lumps is statistically comparable to accurate ultrasonography measurement.
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Affiliation(s)
- J Wasson
- Peterborough and Stamford Hospitals NHS Foundation Trust, UK.
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Meier-Meitinger M, Häberle L, Fasching PA, Bani MR, Heusinger K, Wachter D, Beckmann MW, Uder M, Schulz-Wendtland R, Adamietz B. Assessment of breast cancer tumour size using six different methods. Eur Radiol 2010; 21:1180-7. [PMID: 21191794 DOI: 10.1007/s00330-010-2016-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/24/2010] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Tumour size estimates using mammography (MG), conventional ultrasound (US), compound imaging (CI) and real-time elastography (RTE) were compared with histopathological specimen sizes. METHODS The largest diameters of 97 malignant breast lesions were measured. Two US and CI measurements were made: US1/CI1 (hypoechoic nucleus only) and US2/CI2 (hypoechoic nucleus plus hyperechoic halo). Measurements were compared with histopathological tumour sizes using linear regression and Bland-Altman plots. RESULTS Size prediction was best with ultrasound (US/CI/RTE: R (2) 0.31-0.36); mammography was poorer (R(2) = 0.19). The most accurate method was US2, while US1 and CI1 were poorest. Bland-Altman plots showed better size estimation with US2, CI2 and RTE, with low variation, while mammography showed greatest variability. Smaller tumours were better assessed than larger ones. CI2 and US2 performed best for ductal tumours and RTE for lobular cancers. Tumour size prediction accuracy did not correlate significantly with breast density, but on MG tumours were more difficult to detect in high-density tissue. CONCLUSIONS The size of ductal tumours is best predicted with US2 and CI2, while for lobular cancers RTE is best. Hyperechoic tumour surroundings should be included in US and CI measurements and RTE used as an additional technique in the clinical staging process.
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Verma VP, Kaur N, Agarwal N, Bhargava SK, Singh UR, Saha S, Raheja A. Intra-operative measurement of tumour size in breast cancer and its comparison with other methods: a prospective study. Ecancermedicalscience 2008; 2:96. [PMID: 22275977 PMCID: PMC3234070 DOI: 10.3332/ecancer.2008.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Indexed: 11/16/2022] Open
Abstract
Accurate measurement of breast tumour size determines staging and prognosis. Discrepancies amongst clinical examination (CE), ultrasonography (USG), mammography, pathological examination (PE) and magnetic resonance imaging have been reported. However, few studies have evaluated changes in breast tumour size from the operating table to the laboratory.
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Affiliation(s)
- V P Verma
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi-110095, India
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13
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Interstitial laser thermotherapy (ILT) of breast cancer. Eur J Surg Oncol 2008; 34:739-45. [DOI: 10.1016/j.ejso.2008.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Accepted: 01/08/2008] [Indexed: 11/19/2022] Open
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14
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Conklin C, Huntsman D, Yorida E, Makretsov N, Turbin D, Bechberger JF, Sin WC, Naus CC. Tissue microarray analysis of connexin expression and its prognostic significance in human breast cancer. Cancer Lett 2007; 255:284-94. [PMID: 17583422 DOI: 10.1016/j.canlet.2007.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 04/30/2007] [Accepted: 05/02/2007] [Indexed: 10/23/2022]
Abstract
Breast cancer accounts for approximately 15% of all cancer deaths. Currently, axillary nodal status is the most reliable prognostic indicator for breast cancer. Tumor size and histological grade are used to stage breast cancer. Estrogen receptor/progesterone receptor (ER/PR) and HER-2/neu status are useful in predicting patient survival and relapse. Ki67, an indicator of proliferative activity, also correlates well with prognosis. Connexin proteins form gap junction channels, permitting intercellular exchange of ions and small molecules. Reduced connexin protein levels and impaired gap junctional intercellular communication are associated with tumor phenotypes. This study investigated the prognostic value of connexin proteins as breast cancer markers. Tissue microarrays, containing 438 cases of invasive breast carcinoma, were stained with Cx26, Cx32, and Cx43 antibodies. The degree of connexin immunoreactivity was determined and then correlated with patient outcome, tumor grade, tumor size, lymph node status, and immunohistochemical markers, such as p53, ER/PR status, Ki67 and c-erbB-2 expression. Cx26, Cx32, or Cx43 did not correlate well with tumor grade, tumor size, p53 or c-erbB-2 status. There was an inverse correlation between Cx32 and lymph node status (P <0.05) and a positive correlation between Cx43 and PR status (P <0.01). Cx32 and Cx43 correlated positively with ER status (P <0.01). Cx43 correlated negatively with Ki67 expression (P <0.01). Cx26, Cx32, and Cx43 did not correlate with patient outcome. Based on our observations in this study, connexin proteins do not appear to be reliable indicators of breast cancer prognosis.
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Affiliation(s)
- Chris Conklin
- Department of Cellular & Physiological Sciences, The University of British Columbia, BC, Canada V6T 1Z3
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Heusinger K, Löhberg C, Lux MP, Papadopoulos T, Imhoff K, Schulz-Wendtland R, Beckmann MW, Fasching PA. Assessment of breast cancer tumor size depends on method, histopathology and tumor size itself*. Breast Cancer Res Treat 2006; 94:17-23. [PMID: 16142441 DOI: 10.1007/s10549-005-6653-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Mammography (MG), breast (BU) and axillary ultrasound (AU), and clinical examination (CE) are commonly used for clinical staging. These different methods were compared in order to assess the accuracy of clinical tumor staging (cT). METHOD About 503 breast cancer (BC) patients were prospectively measured by MG, ultrasound and clinical examination. Pearson's correlation to pathological tumor size (pT) was tested and the deviation of MG, BU and CE to pT was analyzed in subgroups defined by pT, grading (G), estrogen receptor (ER), progesteron receptor (PR), proliferation (MIB-1) and HER2/neu. Association of AU to pN was examined by chi(2)-test. Receiver operating characteristics (ROC) were used to test the prediction of a pT > 2 cm. RESULTS Mammography correlated best with pT (r = 0.752). Mammography (mean (MG) = 2.17 cm) overestimated tumors in size (mean (pT) = 2.04 cm) rather than ultrasound (mean (BU) = 1.86 cm) and clinical examination (mean (cT) = 1.70 cm). pT of invasive ductal BC could be estimated significantly better than pT of invasive lobular BC. Smaller tumors were better to assess than larger ones. Tumors with a grading G1 were easier to estimate than tumors with G2/3. Best predictor of a pT > 2 cm was the mammography with an area under the curve of 0.876. The combination of all three modalities by linear regression performed even better with an AUC of 0.906. CONCLUSIONS The dimension of invasive ductal carcinomas, small and low grading tumors is significantly better to estimate. Concerning treatment decisions, we propose a combination of all three modalities, as the best predictive value was seen for the complementary use of mammography, ultrasound and clinical examination.
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Affiliation(s)
- K Heusinger
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
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Cahill RA, Walsh D, Landers RJ, Watson RG. Preoperative Profiling of Symptomatic Breast Cancer by Diagnostic Core Biopsy. Ann Surg Oncol 2006; 13:45-51. [PMID: 16378157 DOI: 10.1245/aso.2006.03.047] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Accepted: 08/07/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Precise preoperative profiling of breast tumors could facilitate fuller consideration of (neo)adjuvant therapies. METHODS Diagnostic core biopsy (DCB) accuracy in profiling the primary tumor was prospectively studied in 95 patients with operable breast cancer. The histological type and grade (hematoxylin and eosin staining) and membrane receptor status (semiquantitative immunohistochemistry for estrogen [ER] and progesterone [PR] receptors, as well as Her-2 antigen expression) were assigned by the DCB before surgery. These measures were then compared with those of the definitive surgical specimen available after operation. RESULTS DCB correctly ascribed tumor type and grade and ER, PR, and Her-2 receptor status in most cases (correlating exactly in 97.5%, 77%, 68%, 71%, and 60%, respectively) with at least moderate concordance (weighted kappa, >.41). When miscategorized, DCB consistently tended to upscore the receptor stain intensity compared with the surgical specimen (22%, 19%, and 27% had higher ER, PR, and Her-2 categorical scores, respectively). ER H-scores correlated best in specimens that stained strongly (224.4 +/- 3 vs. 215.5 +/- 5) and were significantly higher on DCB in those that stained either moderately (195.6 +/- 8.2 vs. 156.8 +/- 5.1; P < .0001) or weakly (157.1 +/- 24.8 vs. 81.4 +/- 4; P = .02). DCB accurately identified all tumors with clinically important ER and Her-2 expression. Furthermore, it promoted three patients into the therapeutically significant range of ER (n = 1) or Her-2 (n = 2) expression. ER negativity on DCB (n = 25) indicated a high-grade tumor (88%), although 11 (44%) patients also overexpressed Her-2. Significant Her-2 expression (n = 16) on DCB predicted the tumor as being poorly differentiated (80%) and both ER and PR negative (67%). CONCLUSIONS DCB accurately profiles clinically relevant measures of primary tumor cell differentiation. It also reliably categorizes patients with regard to (neo)adjuvant therapy before radical surgery is attempted.
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Affiliation(s)
- Ronan A Cahill
- Department of Surgery, Breast Care Unit, Waterford Regional Hospital, Waterford, Ireland.
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