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Muralidharan H, Hansen T, Steinle A, Schumacher D, Stickeler E, Maurer J. Breast Cancer Stem Cells Upregulate IRF6 in Stromal Fibroblasts to Induce Stromagenesis. Cells 2024; 13:1466. [PMID: 39273037 PMCID: PMC11393902 DOI: 10.3390/cells13171466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/11/2024] [Accepted: 08/25/2024] [Indexed: 09/15/2024] Open
Abstract
The microenvironment of a cancer stem cell (CSC) niche is often found in coexistence with cancer-associated fibroblasts (CAFs). Here, we show the first in-depth analysis of the interaction between primary triple-negative breast cancer stem cells (BCSCs) with fibroblasts. Using 2D co-culture models with specific seeding ratios, we identified stromal fibroblast aggregation at the BCSC cluster periphery, and, on closer observation, the aggregated fibroblasts was found to encircle BCSC clusters in nematic organization. In addition, collagen type I and fibronectin accumulation were also found at the BCSC-stromal periphery. MACE-Seq analysis of BCSC-encapsulating fibroblasts displayed the transformation of stromal fibroblasts to CAFs and the upregulation of fibrosis regulating genes of which the Interferon Regulatory Factor 6 (IRF6) gene was identified. Loss of function experiments with the IRF6 gene decreased fibroblast encapsulation around BCSC clusters in 2D co-cultures. In BCSC xenografts, fibroblast IRF6 expression led to an increase in the stromal area and fibroblast density in tumors, in addition to a reduction in necrotic growth. Based on our findings, we propose that fibroblast IRF6 function is an important factor in the development of the stromal microenvironment and in sustaining the BCSC tumor niche.
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Affiliation(s)
- Harshini Muralidharan
- Department of Obstetrics and Gynecology, University Hospital Aachen (UKA), 52074 Aachen, Germany
| | - Thomas Hansen
- Department of Obstetrics and Gynecology, University Hospital Aachen (UKA), 52074 Aachen, Germany
| | - Anja Steinle
- Department of Obstetrics and Gynecology, University Hospital Aachen (UKA), 52074 Aachen, Germany
| | - David Schumacher
- Department of Anesthesiology, University Hospital, RWTH Aachen University, 52074 Aachen, Germany
- Department of Nephrology and Clinical Immunology, RWTH Aachen University, 52074 Aachen, Germany
| | - Elmar Stickeler
- Department of Obstetrics and Gynecology, University Hospital Aachen (UKA), 52074 Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jochen Maurer
- Department of Obstetrics and Gynecology, University Hospital Aachen (UKA), 52074 Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Venusberg-Campus 1, 53127 Bonn, Germany
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Zhang J, Sun H, Gao S, Kang Y, Shang C. Prediction of disease-free survival using strain elastography and diffuse optical tomography in patients with T1 breast cancer: a 10-year follow-up study. BMC Cancer 2024; 24:1057. [PMID: 39192199 DOI: 10.1186/s12885-024-12844-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 08/22/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Early-stage breast cancer (BC) presents a certain risk of recurrence, leading to variable prognoses and complicating individualized management. Yet, preoperative noninvasive tools for accurate prediction of disease-free survival (DFS) are lacking. This study assessed the potential of strain elastography (SE) and diffuse optical tomography (DOT) for non-invasive preoperative prediction of recurrence in T1 BC and developed a prediction model for estimating the probability of DFS. METHODS A total of 565 eligible patients with T1 invasive BC were enrolled prospectively and followed to investigate the recurrence. The associations between imaging features and DFS were evaluated and a best-prediction model for DFS was developed and validated. RESULTS During the median follow-up period of 10.8 years, 77 patients (13.6%) developed recurrences. The fully adjusted Cox proportional hazards model showed a significant trend between an increasing strain ratio (SR) (P < 0.001 for trend) and the total hemoglobin concentration (TTHC) (P = 0.001 for trend) and DFS. In the subgroup analysis, an intensified association between SR and DFS was observed among women who were progesterone receptor (PR)-positive, lower Ki-67 expression, HER2 negative, and without adjuvant chemotherapy and without Herceptin treatment (all P < 0.05 for interaction). Significant interactions between TTHC status and the lymphovascular invasion, estrogen receptor (ER) status, PR status, HER2 status, and Herceptin treatment were found for DFS(P < 0.05).The imaging-clinical combined model (TTHC + SR + clinicopathological variables) proved to be the best prediction model (AUC = 0.829, 95% CI = 0.786-0.872) and was identified as a potential risk stratification tool to discriminate the risk probability of recurrence. CONCLUSION The combined imaging-clinical model we developed outperformed traditional clinical prognostic indicators, providing a non-invasive, reliable tool for preoperative DFS risk stratification and personalized therapeutic strategies in T1 BC. These findings underscore the importance of integrating advanced imaging techniques into clinical practice and offer support for future research to validate and expand on these predictive methodologies.
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Affiliation(s)
- Jing Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang, Liaoning, 110004, China
| | - Hao Sun
- Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Song Gao
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110004, China
| | - Cong Shang
- Department of Ultrasound, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang, Liaoning, 110004, China.
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Deeg J, Swoboda M, Egle D, Wieser V, Soleiman A, Ladenhauf V, Galijasevic M, Amort B, Gruber L. Shear-Wave Elastography Gradient Analysis of Newly Diagnosed Breast Tumours: A Critical Analysis. Diagnostics (Basel) 2024; 14:1657. [PMID: 39125533 PMCID: PMC11312263 DOI: 10.3390/diagnostics14151657] [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: 06/28/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND A better understanding of the peritumoral stroma changes due to tumour invasion using non-invasive diagnostic methods may improve the differentiation between benign and malignant breast lesions. This study aimed to assess the correlation between breast lesion differentiation and intra- and peritumoral shear-wave elastography (SWE) gradients. METHODS A total of 135 patients with newly diagnosed breast lesions were included. Intratumoral, subsurface, and three consecutive peritumoral SWE value measurements (with three repetitions) were performed. Intratumoral, interface, and peritumoral gradients (Gradient 1 and Gradient 2) were calculated using averaged SWE values. Statistical analysis included descriptive statistics and an ordinary one-way ANOVA to compare overall and individual gradients among Breast Imaging-Reporting and Data System (BI-RADS) 2, 3, and 5 groups. RESULTS Malignant tumours showed higher average SWE velocity values at the tumour centre (BI-RADS 2/3: 4.1 ± 1.8 m/s vs. BI-RADS 5: 4.9 ± 2.0 m/s, p = 0.04) and the first peritumoral area (BI-RADS 2/3: 3.4 ± 1.8 m/s vs. BI-RADS 5: 4.3 ± 1.8 m/s, p = 0.003). No significant difference was found between intratumoral gradients (0.03 ± 0.32 m/s vs. 0.0 ± 0.28 m/s; p > 0.999) or gradients across the tumour-tissue interface (-0.17 ± 0.18 m/s vs. -0.13 ± 0.35 m/s; p = 0.202). However, the first peritumoral gradient (-0.16 ± 0.24 m/s vs. -0.35 ± 0.31 m/s; p < 0.0001) and the second peritumoral gradient (-0.11 ± 0.18 m/s vs. -0.22 ± 0.28 m/s; p = 0.037) were significantly steeper in malignant tumours. The AUC was best for PTG1 (0.7358) and PTG2 (0.7039). A threshold value for peritumoral SWI PT1 above 3.76 m/s and for PTG1 below -0.238 m/s·mm-1 indicated malignancy in 90.6% of cases. CONCLUSIONS Evaluating the peritumoral SWE gradient may improve the diagnostic pre-test probability, as malignant tumours showed a significantly steeper curve of the elasticity values in the peritumoral stroma compared to the linear regression with a relatively flat curve of benign lesions.
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Affiliation(s)
- Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Michael Swoboda
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Daniel Egle
- Department of Obstetrics and Gynaecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (D.E.); (V.W.)
| | - Verena Wieser
- Department of Obstetrics and Gynaecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (D.E.); (V.W.)
| | - Afschin Soleiman
- Institute for Pathology, INNPath, University Hospital Tirol Kliniken, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Valentin Ladenhauf
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Malik Galijasevic
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
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Zhou L, Shan J, Zu DM, Deng SH, Zhang Y, Shi XR, Zhu YC, Jiang Q. Value of conventional ultrasound and shear‑wave elastography in the assessment of mesenteric lymphadenitis in a paediatric population. Exp Ther Med 2024; 27:259. [PMID: 38756898 PMCID: PMC11097270 DOI: 10.3892/etm.2024.12547] [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: 01/31/2024] [Accepted: 03/26/2024] [Indexed: 05/18/2024] Open
Abstract
The present retrospective study was designed to explore the value of conventional ultrasound (US) and Virtual Touch Tissue Imaging and Quantification (VTIQ) in the assessment of mesenteric lymphadenitis (ML) in a paediatric population. A total of 103 patients with ML and 60 healthy paediatric patients were examined. VTIQ was performed to assess mesenteric lymph node (MLN) stiffness via shear-wave velocity (SWV). Univariate and multivariate logistic regression analyses were conducted to reveal independent variables for the identification of ML. The diagnostic performance of US, and US combined with VTIQ, were compared. All the quantitative VTIQ parameters (including the SWVMean, SWVMax and SWVMin) were significantly greater for MLNs in the control group than for MLNs in the ML group (all P<0.001). The SWV values in the control group were nearly 2-fold greater than that in the ML group. According to the multivariate logistic regression analysis, the longest diameter [odds ratio (OR)=6.042; P=0.046] was revealed to be the strongest independent predictor for ML, followed by the CRP level (OR=2.310; P<0.001) and the SWVMean (OR=0.106; P<0.001). According to the receiver operating characteristic analysis, the area under the curve (AUC) for US combined with VTIQ was 0.890 (95% CI: 0.831-0.949) with a greater sensitivity of 91.26% and a greater specificity of 86.67% than that for US alone (AUC: 0.798; 95% CI: 0.724-0.872; sensitivity: 79.61%; specificity: 80.00%). A significant negative correlation between increased VTIQ parameters and ML was observed. Utilizing VTIQ to assess MLN stiffness offers a non-invasive, convenient, reliable and reproducible approach for identifying mesenteric lymphadenopathy.
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Affiliation(s)
- Li Zhou
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Jun Shan
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Dao-Ming Zu
- Department of Paediatrics, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Shu-Hao Deng
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Yuan Zhang
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Xiu-Rong Shi
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
| | - Quan Jiang
- Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201200, P.R. China
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Jia W, Xia S, Jia X, Tang B, Cheng S, Nie M, Guan L, Duan Y, Zhang M, Chen X, Zhang H, Bai B, Jia H, Li N, Yuan C, Cai E, Dong Y, Zhang J, Jia Y, Liu J, Tang Z, Luo T, Zhang X, Zhan W, Zhu Y, Zhou J. Ultrasound Viscosity Imaging in Breast Lesions: A Multicenter Prospective Study. Acad Radiol 2024:S1076-6332(24)00159-4. [PMID: 38582684 DOI: 10.1016/j.acra.2024.03.017] [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: 11/27/2023] [Revised: 02/16/2024] [Accepted: 03/17/2024] [Indexed: 04/08/2024]
Abstract
RATIONALE AND OBJECTIVES To explore and validate the clinical value of ultrasound (US) viscosity imaging in differentiating breast lesions by combining with BI-RADS, and then comparing the diagnostic performances with BI-RADS alone. MATERIALS AND METHODS This multicenter, prospective study enrolled participants with breast lesions from June 2021 to November 2022. A development cohort (DC) and validation cohort (VC) were established. Using histological results as reference standard, the viscosity-related parameter with the highest area under the receiver operating curve (AUC) was selected as the optimal one. Then the original BI-RADS would upgrade or not based on the value of this parameter. Finally, the results were validated in the VC and total cohorts. In the DC, VC and total cohorts, all breast lesions were divided into the large lesion, small lesion and overall groups respectively. RESULTS A total of 639 participants (mean age, 46 years ± 14) with 639 breast lesions (372 benign and 267 malignant lesions) were finally enrolled in this study including 392 participants in the DC and 247 in the VC. In the DC, the optimal viscosity-related parameter in differentiating breast lesions was calculated to be A'-S2-Vmax, with the AUC of 0.88 (95% CI: 0.84, 0.91). Using > 9.97 Pa.s as the cutoff value, the BI-RADS was then modified. The AUC of modified BI-RADS significantly increased from 0.85 (95% CI: 0.81, 0.88) to 0.91 (95% CI: 0.87, 0.93), 0.85 (95% CI: 0.80, 0.89) to 0.90 (95% CI: 0.85, 0.93) and 0.85 (95% CI: 0.82, 0.87) to 0.90 (95% CI: 0.88, 0.92) in the DC, VC and total cohorts respectively (P < .05 for all). CONCLUSION The quantitative viscous parameters evaluated by US viscosity imaging contribute to breast cancer diagnosis when combined with BI-RADS.
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Affiliation(s)
- WanRu Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - ShuJun Xia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - XiaoHong Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - BingHui Tang
- Department of Ultrasound, Nanchang People's Hospital, Nanchang, Jiangxi Province 330000, China
| | - ShuZhen Cheng
- Department of Ultrasound, Nanchang People's Hospital, Nanchang, Jiangxi Province 330000, China
| | - MeiYuan Nie
- Department of Ultrasound, Nanchang People's Hospital, Nanchang, Jiangxi Province 330000, China
| | - Ling Guan
- Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, Gansu Province, China
| | - Ying Duan
- Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, Gansu Province, China
| | - MengYan Zhang
- Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, Gansu Province, China
| | - Xia Chen
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Hui Zhang
- Department of Ultrasound, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - BaoYan Bai
- Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi Province, China
| | - HaiYun Jia
- Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi Province, China
| | - Ning Li
- Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, No.2 Ganghenan Road, Anning, Yunnan Province 650330, China
| | - CongCong Yuan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - EnHeng Cai
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - YiJie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - JingWen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - Yi Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - ZhenYun Tang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - XiaoXiao Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - WeiWei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ying Zhu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Guillaumin JB, Djerroudi L, Aubry JF, Tardivon A, Dizeux A, Tanter M, Vincent-Salomon A, Berthon B. Biopathologic Characterization and Grade Assessment of Breast Cancer With 3-D Multiparametric Ultrasound Combining Shear Wave Elastography and Backscatter Tensor Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:474-483. [PMID: 38195266 DOI: 10.1016/j.ultrasmedbio.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/17/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Despite recent improvements in medical imaging, the final diagnosis and biopathologic characterization of breast cancers currently still requires biopsies. Ultrasound is commonly used for clinical examination of breast masses. B-Mode and shear wave elastography (SWE) are already widely used to detect suspicious masses and differentiate benign lesions from cancers. But additional ultrasound modalities such as backscatter tensor imaging (BTI) could provide relevant biomarkers related to tissue organization. Here we describe a 3-D multiparametric ultrasound approach applied to breast carcinomas in the aims of (i) validating the ability of BTI to reveal the underlying organization of collagen fibers and (ii) assessing the complementarity of SWE and BTI to reveal biopathologic features of diagnostic interest. METHODS Three-dimensional SWE and BTI were performed ex vivo on 64 human breast carcinoma samples using a linear ultrasound probe moved by a set of motors. Here we describe a 3-D multiparametric representation of the breast masses and quantitative measurements combining B-mode, SWE and BTI. RESULTS Our results reveal for the first time that BTI can capture the orientation of the collagen fibers around tumors. BTI was found to be a relevant marker for assessing cancer stages, revealing a more tangent tissue orientation for in situ carcinomas than for invasive cancers. In invasive cases, the combination of BTI and SWE parameters allowed for classification of invasive tumors with respect to their grade with an accuracy of 95.7%. CONCLUSION Our results highlight the potential of 3-D multiparametric ultrasound imaging for biopathologic characterization of breast tumors.
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Affiliation(s)
- Jean-Baptiste Guillaumin
- Physics for Medicine Institute, ESPCI Paris, PSL Research University, Inserm U1273, CNRS UMR 8063, Paris, France
| | | | - Jean-François Aubry
- Physics for Medicine Institute, ESPCI Paris, PSL Research University, Inserm U1273, CNRS UMR 8063, Paris, France.
| | | | - Alexandre Dizeux
- Physics for Medicine Institute, ESPCI Paris, PSL Research University, Inserm U1273, CNRS UMR 8063, Paris, France
| | - Mickaël Tanter
- Physics for Medicine Institute, ESPCI Paris, PSL Research University, Inserm U1273, CNRS UMR 8063, Paris, France
| | | | - Béatrice Berthon
- Physics for Medicine Institute, ESPCI Paris, PSL Research University, Inserm U1273, CNRS UMR 8063, Paris, France
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Kwon MR, Youn I, Ko ES, Choi SH. Correlation of shear-wave elastography stiffness and apparent diffusion coefficient values with tumor characteristics in breast cancer. Sci Rep 2024; 14:7180. [PMID: 38531932 DOI: 10.1038/s41598-024-57832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/22/2024] [Indexed: 03/28/2024] Open
Abstract
We aimed to investigate the correlation between shear-wave elastography (SWE) and apparent diffusion coefficient (ADC) values in breast cancer and to identify the associated characteristics. We included 91 breast cancer patients who underwent SWE and breast MRI prior to surgery between January 2016 and November 2017. We measured the lesion's mean (Emean) and maximum (Emax) elasticities of SWE and ADC values. We evaluated the correlation between SWE, ADC values and tumor size. The mean SWE and ADC values were compared for categorical variable of the pathological/imaging characteristics. ADC values showed negative correlation with Emean (r = - 0.315, p = 0.002) and Emax (r = - 0.326, p = 0.002). SWE was positively correlated with tumor size (r = 0.343-0.366, p < 0.001). A higher SWE value indicated a tendency towards a higher T stage (p < 0.001). Triple-negative breast cancer showed the highest SWE values (p = 0.02). SWE were significantly higher in breast cancers with posterior enhancement, vascularity, and washout kinetics (p < 0.02). SWE stiffness and ADC values were negatively correlated in breast cancer. SWE values correlated significantly with tumor size, and were higher in triple-negative subtype and aggressive imaging characteristics.
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Affiliation(s)
- Mi-Ri Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Seon-Hyeong Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Queen's U Clinic, Seoul, South Korea
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Xing X, Miao H, Wang H, Sun J, Wu C, Wang Y, Zhou X, Wang H. A Model Combining Conventional Ultrasound Characteristics, Strain Elastography and Clinicopathological Features to Predict Ki-67 Expression in Small Breast Cancer. ULTRASONIC IMAGING 2024; 46:121-129. [PMID: 38197383 DOI: 10.1177/01617346231218933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
To establish a predictive model incorporating conventional ultrasound, strain elastography and clinicopathological features for Ki-67 expression in small breast cancer (SBC) which defined as maximum diameter less than2 cm. In this retrospective study, 165 SBC patients from our hospital were allocated to a high Ki-67 group (n = 104) and a low Ki-67 group (n = 61). Multivariate regression analysis was performed to identify independent indicators for developing predictive models. The area under the receiver operating characteristic (AUC) curve was also determined to establish the diagnostic performance of different predictive models. The corresponding sensitivities and specificities of different models at the cutoff value were compared. Conventional ultrasound parameters (spiculated margin, absence of posterior shadowing and Adler grade 2-3), strain elastic scores and clinicopathological information (HER2 positive) were significantly correlated with high expression of Ki-67 in SBC (all p < .05). Model 2, which incorporated conventional ultrasound features and strain elastic scores, yielded good diagnostic performance (AUC = 0.774) with better sensitivity than model 1, which only incorporated ultrasound characteristics (78.85%vs. 55.77%, p = .000), with specificities of 77.05% and 62.30% (p = .035), respectively. Model 3, which incorporated conventional ultrasound, strain elastography and clinicopathological features, yielded better performance (AUC = 0.853) than model 1 (AUC = 0.694) and model 2 (AUC = 0.774), and the specificity was higher than model 1 (86.89% vs. 77.05%, p = .001). The predictive model combining conventional ultrasound, strain elastic scores and clinicopathological features could improve the predictive performance of Ki-67 expression in SBC.
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Affiliation(s)
- Xuesha Xing
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huanhuan Miao
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiawei Sun
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chengwei Wu
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yichun Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xianli Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongbo Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Yao J, Zhou W, Zhu Y, Zhou J, Chen X, Zhan W. Predictive nomogram using multimodal ultrasonographic features for axillary lymph node metastasis in early‑stage invasive breast cancer. Oncol Lett 2024; 27:95. [PMID: 38288042 PMCID: PMC10823315 DOI: 10.3892/ol.2024.14228] [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: 08/10/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
Axillary lymph node (ALN) status is a key prognostic factor in patients with early-stage invasive breast cancer (IBC). The present study aimed to develop and validate a nomogram based on multimodal ultrasonographic (MMUS) features for early prediction of axillary lymph node metastasis (ALNM). A total of 342 patients with early-stage IBC (240 in the training cohort and 102 in the validation cohort) who underwent preoperative conventional ultrasound (US), strain elastography, shear wave elastography and contrast-enhanced US examination were included between August 2021 and March 2022. Pathological ALN status was used as the reference standard. The clinicopathological factors and MMUS features were analyzed with uni- and multivariate logistic regression to construct a clinicopathological and conventional US model and a MMUS-based nomogram. The MMUS nomogram was validated with respect to discrimination, calibration, reclassification and clinical usefulness. US features of tumor size, echogenicity, stiff rim sign, perfusion defect, radial vessel and US Breast Imaging Reporting and Data System category 5 were independent risk predictors for ALNM. MMUS nomogram based on these factors demonstrated an improved calibration and favorable performance [area under the receiver operator characteristic curve (AUC), 0.927 and 0.922 in the training and validation cohorts, respectively] compared with the clinicopathological model (AUC, 0.681 and 0.670, respectively), US-depicted ALN status (AUC, 0.710 and 0.716, respectively) and the conventional US model (AUC, 0.867 and 0.894, respectively). MMUS nomogram improved the reclassification ability of the conventional US model for ALNM prediction (net reclassification improvement, 0.296 and 0.288 in the training and validation cohorts, respectively; both P<0.001). Taken together, the findings of the present study suggested that the MMUS nomogram may be a promising, non-invasive and reliable approach for predicting ALNM.
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Affiliation(s)
- Jiejie Yao
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Ying Zhu
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Xiaosong Chen
- Comprehensive Breast Health Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P.R. China
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Sun K, Zhu Y, Chai W, Zhu H, Fu C, Zhan W, Yan F. Diffusion-Weighted MRI-Based Virtual Elastography and Shear-Wave Elastography for the Assessment of Breast Lesions. J Magn Reson Imaging 2024. [PMID: 38376448 DOI: 10.1002/jmri.29302] [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: 11/21/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI)-based virtual MR elastography (DWI-vMRE) in the assessment of breast lesions is still in the research stage. PURPOSE To investigate the usefulness of elasticity values on DWI-vMRE in the evaluation of breast lesions, and the correlation with the values calculated from shear-wave elastography (SWE). STUDY TYPE Prospective. POPULATION/SUBJECTS 153 patients (mean age ± standard deviation: 55 ± 12 years) with 153 pathological confirmed breast lesions (24 benign and 129 malignant lesions). FIELD STRENGTH/SEQUENCE 1.5-T MRI, multi-b readout segmented echo planar imaging (b-values of 0, 200, 800, and 1000 sec/mm2 ). ASSESSMENT For DWI-vMRE assessment, lesions were manually segmented using apparent diffusion coefficient (ADC0-1000 ) map, then the region of interests were copied to the map of shifted-ADC (sADC200-800 , sADC 200-1500 ). For SWE assessment, the shear modulus of the lesions was measured by US elastic modulus (μUSE ). Intraclass/interclass kappa coefficients were calculated to measure the consistency. STATISTICAL TESTS Pearson's correlation was used to assess the relationship between sADC and μUSE . A receiver operating characteristic analysis with the area under the curve (AUC) was performed to compare the diagnostic accuracy between benign and malignant breast lesions of sADC and μUSE . A P value <0.05 was considered statistically significant. RESULTS There were significant differences between benign and malignant breast lesions of μUSE (24.17 ± 10.64 vs. 37.20 ± 12.61), sADC200-800 (1.38 ± 0.31 vs. 0.97 ± 0.18 × 10-3 mm2 /sec), and sADC200-1500 (1.14 ± 0.30 vs. 0.78 ± 0.13 × 10-3 mm2 /sec). In all breast lesions, a moderate but significant correlation was observed between μUSE and sADC200-800 /sADC200-1500 (r = -0.49/-0.44). AUC values to differentiate benign from malignant lesions were as follows: μUSE , 0.78; sADC200-800 , 0.89; sADC200-1500 , 0.89. DATA CONCLUSIONS Both SWE and DWI-vMRE could be used for the differentiation of benign versus malignant breast lesions. Furthermore, DWI-vMRE with the use of sADC show relatively higher AUC values than SWE. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Kun Sun
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Zhu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weimin Chai
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hong Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Caixia Fu
- Application development, Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Slomka G, Schleip R, Frei P, Kurpiers N, Krämer M, Bauermeister K, Bauermeister W. The Influence of Mobility Training on the Myofascial Structures of the Back and Extremities. J Clin Med 2024; 13:329. [PMID: 38256463 PMCID: PMC10816048 DOI: 10.3390/jcm13020329] [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: 10/28/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The subject of the study was the effect of a multicomponent program (Mobility Routine) on muscular and fascial stiffness, flexibility, subjective well-being, and body perception. METHODS The assumption was that high physical stress affects myofascial structures and joint range of motion. The assessment of myofascial stiffness employed a Shear Wave Elastography. The joint flexibility, pressure pain threshold, and subjective experiences with regard to tension, pain, and general discomfort were documented. RESULTS In the CT group, a greater increase in stiffness was measured in fewer measurement areas compared to the MR group. MR demonstrated superior gains in flexibility compared to CT. Both groups experienced significant reductions in pain, tension, and discomfort. In conclusion, repetitive motion patterns akin to CT lead to increased myofascial stiffness, whereas MR yields more balanced stiffness development, compensates for asymmetries, and improves body awareness. CONCLUSIONS Hence, this study highlights the advantages of mobility training over Crosstrainer exercises and provides valuable insights for the recommendation of training regimens aiming at the enhancement of musculoskeletal functionality and overall well-being.
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Affiliation(s)
- Gunda Slomka
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department Sport and Health Sciences, Technical University of Munich, Campus D, Georg-Bauchle-Ring 60/62, 80992 München, Germany;
- Department of Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allen, Germany
| | - Peter Frei
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Nicolas Kurpiers
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Michael Krämer
- Institute for Materials Technology, Technical University Darmstadt, Grafenstrasse 2, 64283 Darmstadt, Germany;
| | - Katharina Bauermeister
- Conservative and Rehabilitative Orthopedics, Department Sport and Health Sciences, Technical University of Munich, Campus D, Georg-Bauchle-Ring 60/62, 80992 München, Germany;
| | - Wolfgang Bauermeister
- Department of Sports, Physical and Rehabilitative Medicine, Kharkiv National Medical University, 4 Nauky Avenue, 61022 Kharkiv, Ukraine;
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12
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Mierke CT. Extracellular Matrix Cues Regulate Mechanosensing and Mechanotransduction of Cancer Cells. Cells 2024; 13:96. [PMID: 38201302 PMCID: PMC10777970 DOI: 10.3390/cells13010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
Extracellular biophysical properties have particular implications for a wide spectrum of cellular behaviors and functions, including growth, motility, differentiation, apoptosis, gene expression, cell-matrix and cell-cell adhesion, and signal transduction including mechanotransduction. Cells not only react to unambiguously mechanical cues from the extracellular matrix (ECM), but can occasionally manipulate the mechanical features of the matrix in parallel with biological characteristics, thus interfering with downstream matrix-based cues in both physiological and pathological processes. Bidirectional interactions between cells and (bio)materials in vitro can alter cell phenotype and mechanotransduction, as well as ECM structure, intentionally or unintentionally. Interactions between cell and matrix mechanics in vivo are of particular importance in a variety of diseases, including primarily cancer. Stiffness values between normal and cancerous tissue can range between 500 Pa (soft) and 48 kPa (stiff), respectively. Even the shear flow can increase from 0.1-1 dyn/cm2 (normal tissue) to 1-10 dyn/cm2 (cancerous tissue). There are currently many new areas of activity in tumor research on various biological length scales, which are highlighted in this review. Moreover, the complexity of interactions between ECM and cancer cells is reduced to common features of different tumors and the characteristics are highlighted to identify the main pathways of interaction. This all contributes to the standardization of mechanotransduction models and approaches, which, ultimately, increases the understanding of the complex interaction. Finally, both the in vitro and in vivo effects of this mechanics-biology pairing have key insights and implications for clinical practice in tumor treatment and, consequently, clinical translation.
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Affiliation(s)
- Claudia Tanja Mierke
- Biological Physics Division, Peter Debye Institute of Soft Matter Physics, Faculty of Physics and Earth Science, Leipzig University, Linnéstraße 5, 04103 Leipzig, Germany
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13
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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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14
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Kayadibi Y, Deger E, Kurt SA, Ucar AK, Adaletli I, Ozturk T, Kocael CP, Velidedeoglu M, Icten GE. The Diagnostic Role of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Suspicious Microcalcifications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2295-2306. [PMID: 37146224 DOI: 10.1002/jum.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the role of superb microvascular imaging (SMI) and shear wave elastography (SWE) in the prediction of malignancy and invasiveness of isolated microcalcifications (MC) that can be visualized by ultrasonography (US). MATERIAL AND METHODS Sixty-seven women with MC, who were considered suspicious on mammography were evaluated. Only those lesions that could be visualized by US and presented as non-mass lesion were included. They were evaluated by B-mode US, SMI, and SWE before US-guided core-needle biopsy. B-mode US, SMI (vascular index (SMIvi)), and SWE (E-mean, E-ratio) findings were compared with histopathologic features. RESULTS Pathology confirmed 45 malignant (21 invasive and 24 in situ carcinomas) and 22 benign lesions. There was a statistically significant difference between malignant and benign groups in terms of size (P = .015), distortion (P = .028), cystic component (P < .001), E-mean (P < .001), E-ratio (P < .001), and SMIvi (P = .006). For differentiation of invasiveness E-mean (P = .002), E-ratio (P = .002), and SMIvi (P = .030) were statistically significant. According to ROC analysis E-mean (cut-off point at 38 kPa) was the most sensitive (78%) and the most specific (95%) value among four numeric parameters (size, SMI, E-mean, and E-ratio) with AUC = 0.895, PPV = 97%, and NPV = 68% in detecting malignancy. In the evaluation of invasiveness, the most sensitive (71.4%) method was SMI (cut-off point at 3.4) and the most specific (72%) method was E-mean (cut-off point at 91.5 kPa). CONCLUSION Our study shows that adding SWE and SMI to the sonographic evaluation of MC would be an advantage for US-guided biopsy. Including suspicious areas according to SMI and SWE in the sampling area can help target the invasive part of the lesion and avoid underestimation of core biopsy.
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Affiliation(s)
- Yasemin Kayadibi
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Enes Deger
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seda Aladag Kurt
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Kalyoncu Ucar
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ibrahim Adaletli
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tulin Ozturk
- Cerrahpasa Medical Faculty, Department of Pathology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Pinar Kocael
- Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Velidedeoglu
- Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gul Esen Icten
- Senology Research Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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15
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Bae MS, Kim HY, Oh H, Seo BK. Clinical applications of shear wave dispersion imaging for breast lesions: a pictorial essay. Ultrasonography 2023; 42:589-599. [PMID: 37691417 PMCID: PMC10555686 DOI: 10.14366/usg.23079] [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: 04/27/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Shear wave dispersion (SWD) imaging is a newly developed ultrasound technology designed to evaluate the dispersion slope of shear waves, which is related to tissue viscosity. This advanced imaging technique holds potential for distinguishing malignant lesions from benign lesions and normal breast tissue. The SWD slope, as determined by shear wave elastography (SWE), could offer crucial insights into the characterization of breast lesions. This article presents SWE and SWD images of both malignant and benign breast lesions, in addition to normal breast tissue.
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Affiliation(s)
- Min Sun Bae
- Department of Radiology, Inha University Hospital and College of Medicine, Incheon, Korea
| | - Hyo Young Kim
- Department of Radiology, Korea University Ansan Hospital, Korea
University College of Medicine, Ansan, Korea
| | - Hyunseung Oh
- Department of Pathology, Korea University Ansan Hospital, Korea
University College of Medicine, Ansan, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea
University College of Medicine, Ansan, Korea
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16
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Zhong X, Long H, Chen L, Xie Y, Shi Y, Peng J, Zheng R, Su L, Duan Y, Xie X, Lin M. Stiffness on shear wave elastography as a potential microenvironment biomarker for predicting tumor recurrence in HBV-related hepatocellular carcinoma. Insights Imaging 2023; 14:147. [PMID: 37697029 PMCID: PMC10495298 DOI: 10.1186/s13244-023-01505-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND To explore the pathologic basis and prognostic value of tumor and liver stiffness measured pre-operatively by two-dimensional shear wave elastography (2D-SWE) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients who undergo hepatic resection. METHODS A total of 191 HBV-infected patients with solitary resectable HCC were prospectively enrolled. The stiffness of intratumoral tissue, peritumoral tissue, adjacent liver tissue, and distant liver tissue was evaluated by 2D-SWE. The correlations between stiffness and pathological characteristics were analyzed in 114 patients. The predictive value of stiffness for recurrence-free survival (RFS) was evaluated, and Cutoff Finder was used for determining optimal cut-off stiffness values. Cox proportional hazards analysis was used to identify independent predictors of RFS. RESULTS Pathologically, intratumoral stiffness was associated with stroma proportion and microvascular invasion (MVI) while peritumoral stiffness was associated with tumor size, capsule, and MVI. Adjacent liver stiffness was correlated with capsule and liver fibrosis stage while distant liver stiffness was correlated with liver fibrosis stage. Peritumoral stiffness, adjacent liver stiffness, and distant liver stiffness were all correlated to RFS (all p < 0.05). Higher peritumoral stiffness (> 49.4 kPa) (HR = 1.822, p = 0.023) and higher adjacent liver stiffness (> 24.1 kPa) (HR = 1.792, p = 0.048) were significant independent predictors of worse RFS, along with tumor size and MVI. The nomogram based on these variables showed a C-index of 0.77 for RFS prediction. CONCLUSIONS Stiffness measured by 2D-SWE could be a tumor microenvironment and tumor invasiveness biomarker. Peritumoral stiffness and adjacent liver stiffness showed important values in predicting tumor recurrence after curative resection in HBV-related HCC. CLINICAL RELEVANCE STATEMENT Tumor and liver stiffness measured by two-dimensional shear wave elastography serve as imaging biomarkers for predicting hepatocellular carcinoma recurrence, reflecting biological behavior and tumor microenvironment. KEY POINTS • Stiffness measured by two-dimensional shear wave elastography is a useful biomarker of tumor microenvironment and invasiveness. • Higher stiffness indicated more aggressive behavior of hepatocellular carcinoma. • The study showed the prognostic value of peritumoral stiffness and adjacent liver stiffness for recurrence-free survival. • The nomogram integrating peritumoral stiffness, adjacent liver stiffness, tumor size, and microvascular invasion showed a C-index of 0.77.
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Affiliation(s)
- Xian Zhong
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Haiyi Long
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yuhua Xie
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yifan Shi
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Jianyun Peng
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Ruiying Zheng
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Liya Su
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yu Duan
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Xiaoyan Xie
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Manxia Lin
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China.
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Gruber L, Deeg J, Egle D, Soleiman A, Ladenhauf V, Luger A, Amort B, Daniaux M. Peritumoural Strain Elastography of Newly Diagnosed Breast Tumours: Does Maximum Peritumoural Halo Depth Correlate with Tumour Differentiation and Grade? Diagnostics (Basel) 2023; 13:2064. [PMID: 37370959 DOI: 10.3390/diagnostics13122064] [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: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
To evaluate the diagnostic utility of the maximum ultrasound strain elastography (SE) halo depth in newly diagnosed and histologically confirmed breast lesions, a retrospective study approval was granted by the local Ethical Review Board. Overall, the maximum strain elastography peritumoural halos (SEPHmax)-the maximum distance between the SE stiffening area and the B-mode lesion size-in 428 cases with newly diagnosed breast lesions were retrospectively analysed alongside patient age, affected quadrant, tumour echogenicity, size, acoustic shadowing, and vascularity. Statistical analysis included an ordinary one-way ANOVA to compare the SEPHmax between BI-RADS 2, 3, and 5 groups and between tumour grades 1, 2, and 3. A binary regression analysis was used to determine the correlation between tumour malignancy and the above-mentioned demographic and imaging factors. SEPHmax was significantly higher in BI-RADS 5 tumours (5.5 ± 3.9 mm) compared to BI-RADS 3 (0.9 ± 1.7 mm, p < 0.0001) and 2 (0.6 ± 1.4 mm, p < 0.0001). The receiver operating characteristic area under the curve was 0.933 for the detection of BI-RADS 5 lesions. Furthermore, tumour grades 2 (5.6 ± 3.6 mm, p = 0.001) and 3 (6.8 ± 4.2 mm, p < 0.0001) exhibited significantly higher SEPHmax than grade 1 tumours (4.0 ± 3.9 mm). Similarly, St. Gallen Ki67-stratified low-risk (p = 0.005) and intermediate-risk (p = 0.013) tumours showed smaller SEPHmax than high-risk tumours. Multivariate analysis revealed a significant correlation between malignant differentiation and SEPHmax (standardized regression coefficient 3.17 [95% confidence interval (CI) 2.42-3.92], p < 0.0001), low tumour echogenicity (1.68 [95% CI 0.41-3.00], p = 0.03), and higher patient age (0.89 [95% CI 0.52-1.26], p < 0.0001). High SEPHmax is a strong predictor for tumour malignancy and a higher tumour grade and can be used to improve tumour characterisation before histopathological evaluation. It may also enable radiologists to identify lesions warranting observation rather than immediate biopsy.
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Affiliation(s)
- Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynaecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Afschin Soleiman
- Institute for Pathology, INNPath, University Hospital Tirol Kliniken, Anichstraße 35, 6020 Innsbruck, Austria
| | - Valentin Ladenhauf
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Anna Luger
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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18
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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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19
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Avdan Aslan A, Gültekin S, İnan MA. The Utility of Quantitative Parameters of Shear-Wave Elastography to Predict Prognostic Histologic Features of Breast Cancer. Ultrasound Q 2023; 39:81-85. [PMID: 36892515 DOI: 10.1097/ruq.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
ABSTRACT In this study, we aimed to investigate the correlation of stiffness values of shear-wave elastography (SWE) and histopathological prognostic factors in patients with breast cancer. Between January 2021 and June 2022, SWE images of 138 core-biopsy proven breast cancer lesions from 132 patients were retrospectively reviewed. Histopathogic prognostic factors, including tumor size, histologic grade, histologic type, hormone receptor positivity, human epidermal growth factor receptor (HER2) status, immunohistochemical subtype and Ki-67 index were documented. Elasticity values including mean and maximum elasticity ( Emean and Emax ) and lesion-to-fat ratio ( Eratio ) were recorded. The association between histopathological prognostic factors and elasticity values were assessed using Mann-Whitney U and Kruskal-Wallis test, and multiple linear regression analysis. Tumor size, histological grade, and Ki-67 index were significantly associated with the Eratio ( P < 0.05). Larger tumor size and higher Ki-67 index also showed significantly higher Emean and Emax values ( P < 0.05). However, hormone receptor positivity, HER2 status, and immunohistochemical subtype were not significantly associated with elasticity values ( P > 0.05). Multivariate logistic regression analysis revealed that tumor size was significantly associated with Emean , Emax , and Eratio values ( P < 0.05). A high Ki-67 index was also significantly associated with high Eratio values. Larger tumor size and higher Ki-67 index are independently associated with high Eratio values. Preoperative SWE may improve the performance of conventional ultrasound in predicting prognosis and treatment planning.
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Affiliation(s)
| | | | - Mehmet Arda İnan
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
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20
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Yang D, Zhuang B, Zheng Y, Xu M, Lin J, Zhang X, Wang C, Xie X, Huang G, Xie X, Wang Y. Shear wave elastography using high-frequency linear probe for transplant kidney monitoring: A methodological study. Clin Hemorheol Microcirc 2023:CH221668. [PMID: 37125543 DOI: 10.3233/ch-221668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To investigate the influencing factors of the image quality of shear wave elastography (SWE) performed using a high-frequency probe and its reproducibility for renal allografts. METHODS A total of 211 patients with transplanted kidneys who underwent SWE examination performed using high-frequency or low-frequency probes were recruited for the study. The reproducibility of inter- and intraobserver agreements were analysed by using the intraclass correlation coefficient (ICC). According to the colour filling of the area of interest and imaging noise when conducting SWE, the image quality was classified as three grades: "good", "common", and "poor". A logistic regression was used to analyse the independent factors for SWE quality. RESULTS In the comparative analysis, high frequency, transection measurement and middle pole were selected as the appropriate measurement methods. Regarding reproducibility, the ICCs) of the intra- and interobserver agreements were 0.85 and 0.77, respectively. Multivariate analysis indicated that only the skin allograft distance and kidney width were independent variables for SWE quality. In the subgroup analysis of the skin-allograft distance, the "good" and "common" rates of images decreased as the distance increased, but the CV (coefficients of variation) showed the opposite trend. The SWE quality of kidney width <5.4 cm was significantly better than that of kidney width ≥5.4 cm. CONCLUSIONS High-frequency SWE can be used in the evaluation of transplanted kidneys due to its good repeatability and high successful measurement rate, but we should pay attention to the influence of the skin-allograft distance and kidney width on SWE quality.
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Affiliation(s)
- Daopeng Yang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bowen Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanling Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jinhua Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoer Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gang Huang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaohua Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yan Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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21
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Ece B, Aydin S. Can Shear Wave Elastography Help Differentiate Acute Tonsillitis from Normal Tonsils in Pediatric Patients: A Prospective Preliminary Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:704. [PMID: 37189953 PMCID: PMC10136413 DOI: 10.3390/children10040704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
Shear wave elastography (SWE) is a non-invasive imaging technique used to quantify the elasticity/stiffness of any tissue. There are normative SWE studies on tonsils in healthy children in the literature. The purpose of this study is to analyze the palatine tonsils in children with acute tonsillitis using ultrasound and SWE. In this prospective study, pediatric patients aged 4-18 years diagnosed with acute tonsillitis and healthy children were included. Those with antibiotic use, chronic tonsillitis, adenoid hypertrophy, and having chronic disease, immunodeficiency, and autoimmune disease, or any rheumatological disease were excluded. The volume and elasticity of palatine tonsil were measured via ultrasound and SWE. The study included 81 (46 female, 35 male) acute tonsillitis patients, and 63 (38 female, 25 male) healthy children between the ages of 4 and 18. Elasticity (kPa) values of tonsils were found significantly higher in the tonsillitis group (SWE-R: 25.39 ± 4.64, SWE-L: 25.01 ± 4.17) compared to the normal group (SWE-R: 9.71 ± 2.37, SWE-L: 9.39 ± 2.19) (p < 0.001). In the tonsillitis group, a significant positive correlation was found between tonsil volume and elasticity (r: 0.774, p: 0.002). In conclusion, in pediatric patients with acute tonsillitis, higher kPa values were obtained with SWE in the palatine tonsils.
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Affiliation(s)
- Bunyamin Ece
- Department of Radiology, Kastamonu University, Kastamonu 37150, Turkey;
| | - Sonay Aydin
- Department of Radiology, Erzincan University, Erzincan 24100, Turkey
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22
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Wang D, Zhang M, Qiu G, Rong C, Zhu X, Qin G, Kong C, Zhou J, Liang X, Bu Z, Liu J, Luo T, Yang J, Zhang K. Extracellular Matrix Viscosity Reprogramming by In Situ Au Bioreactor-Boosted Microwavegenetics Disables Tumor Escape in CAR-T Immunotherapy. ACS NANO 2023; 17:5503-5516. [PMID: 36917088 DOI: 10.1021/acsnano.2c10845] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Incomplete microwave ablation (iMWA) caused by uncontrollable heat diffusion enhances the immunosuppressive tumor microenvironment (ITM), consequently disabling the prevalent immune checkpoint blockade-combined immunotherapy against tumor recurrence. Herein, we successfully constructed an intratumorally synthesized Au bioreactor to disperse heat in thermally sensitive hydrogel-filled tumors and improve the energy utilization efficiency, which magnified the effective ablation zone (EAZ), counteracted iMWA, and simultaneously established and enhanced multiple biological process-regulated microwavegenetics. More significantly, we identified the extracellular matrix (ECM) viscosity as a general immune escape "target". After remodeling ECM, including ECM ingredients and cell adhesion molecules, this physical target was blocked by viscosity reprogramming, furnishing an effective tool to regulate the viscosity target. Thereby, such in situ Au bioreactor-enlarged EAZ and enhanced microwavegenetics reversed the immune-desert tumor microenvironment, mitigated ITM, secreted immune cell-attracting chemokines, recruited and polarized various immune cells, and activated or reactivated them like dendritic cells, natural killing cells, M1-type macrophages, and effector CD8+ or CAR-T cells. Contributed by these multiple actions, the in situ oncolytic Au bioreactors evoked CAR-T immunotherapy to acquire a considerably increased inhibition effect against tumor progression and recurrence after iMWA, thus providing a general method to enhance iMWA and CAR-T immunotherapy.
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Affiliation(s)
- Duo Wang
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Mengqi Zhang
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Guanhua Qiu
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Chao Rong
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Xiaoqi Zhu
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Guchun Qin
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Cunqing Kong
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Jing Zhou
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
- Central Laboratory, Department of Medical Ultrasound, and Shanghai Tenth People's Hospital, Tongji University School of Medicine, Tongji University. No. 301 Yanchangzhong Road, Shanghai 200072, P.R. China
| | - Xiayi Liang
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
- Central Laboratory, Department of Medical Ultrasound, and Shanghai Tenth People's Hospital, Tongji University School of Medicine, Tongji University. No. 301 Yanchangzhong Road, Shanghai 200072, P.R. China
| | - Zhaoting Bu
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
- Central Laboratory, Department of Medical Ultrasound, and Shanghai Tenth People's Hospital, Tongji University School of Medicine, Tongji University. No. 301 Yanchangzhong Road, Shanghai 200072, P.R. China
| | - Junjie Liu
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Tao Luo
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
| | - Jianjun Yang
- Central Laboratory, Department of Medical Ultrasound, and Shanghai Tenth People's Hospital, Tongji University School of Medicine, Tongji University. No. 301 Yanchangzhong Road, Shanghai 200072, P.R. China
| | - Kun Zhang
- Department of Medical Ultrasound, Department of Gastrointestinal Surgery, National Center for International Research of Bio-targeting Theranostics, Guangxi Medical University Cancer Hospital, Guangxi Medical University. No. 71 Hedi Road, Nanning 530021, Guangxi, P.R. China
- Central Laboratory, Department of Medical Ultrasound, and Shanghai Tenth People's Hospital, Tongji University School of Medicine, Tongji University. No. 301 Yanchangzhong Road, Shanghai 200072, P.R. China
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23
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Liu X, Ye Y, Zhu L, Xiao X, Zhou B, Gu Y, Si H, Liang H, Liu M, Li J, Jiang Q, Li J, Yu S, Ma R, Su S, Liao JY, Zhao Q. Niche stiffness sustains cancer stemness via TAZ and NANOG phase separation. Nat Commun 2023; 14:238. [PMID: 36646707 PMCID: PMC9842735 DOI: 10.1038/s41467-023-35856-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Emerging evidence shows that the biomechanical environment is required to support cancer stem cells (CSCs), which play a crucial role in drug resistance. However, how mechanotransduction signals regulate CSCs and its clinical significance has remained unclear. Using clinical-practice ultrasound elastography for patients' lesions and atomic force microscopy for surgical samples, we reveal that increased matrix stiffness is associated with poor responses to neoadjuvant chemotherapy, worse prognosis, and CSC enrichment in patients with breast cancer. Mechanically, TAZ activated by biomechanics enhances CSC properties via phase separation with NANOG. TAZ-NANOG phase separation, which is dependent on acidic residues in the N-terminal activation domain of NANOG, promotes the transcription of SOX2 and OCT4. Therapeutically, targeting NANOG or TAZ reduces CSCs and enhances the chemosensitivity in vivo. Collectively, this study demonstrated that the phase separation of a pluripotency transcription factor links mechanical cues in the niche to the fate of CSCs.
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Affiliation(s)
- Xinwei Liu
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China.,Department of Breast Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450000, China.,Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Yingying Ye
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Xiaoyun Xiao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Boxuan Zhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Yuanting Gu
- Department of Breast Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450000, China
| | - Hang Si
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China.,Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Huixin Liang
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China.,Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Mingzhu Liu
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China.,Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Jiaqian Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Qiongchao Jiang
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Jiang Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Shubin Yu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Ruiying Ma
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China.,Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Shicheng Su
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China. .,Department of Breast Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450000, China. .,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China. .,Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China. .,Department of Immunology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Jian-You Liao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
| | - Qiyi Zhao
- Department of Infectious Diseases, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China. .,Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China.
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24
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Chen CT, Huang TW, Chou YS, Cheng CF, Wu HB, Hsu CH, Hsiu H. Effects of anthracycline chemotherapy and Kuan-Sin-Yin on the spectral indices of arterial pulse waveforms in breast cancer patients. Clin Hemorheol Microcirc 2023; 84:345-358. [PMID: 37334580 DOI: 10.3233/ch-221602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The vascular structure and function are potentially useful biomarkers for tumor detection. Treatment with chemotherapeutic agents may impair vascular function and increase the risk of cardiovascular disease. This study aimed to use noninvasive pulse waveform measurements to identify differences in the frequency-domain indices of the pulse waveform in breast-cancer patients following anthracycline chemotherapy between with (Group KSY) and without (Group NKSY) receiving Kuan-Sin-Yin (KSY) treatment.Radial blood pressure waveform (BPW) signals were measured noninvasively for 3 minutes in 31 patients, and the FACT-G, BFI-T, and EORTC QLQ-C30 questionnaires were administered. The following pulse indices were calculated for 10 harmonics: the amplitude proportion and its coefficient of variation, and the phase angle and its standard deviation.The changes in spectral BPW indices were more prominent in Group NKSY than in Group KSY, especially for the decreases in BPW variability indices. Scores on the FACT-G, BFI-T, and EORTC QLQ-C30 questionnaires suggested that the quality of life following chemotherapy was better in Group KSY.The identified decreases in pulse variability indices could be related to the greater impairment of regulatory activities in Group NKSY. The present findings may be meaningful in developing techniques with advantages such as being noninvasive and time-saving to evaluate the blood supply and physiological conditions following chemotherapy or other treatment strategies in cancer patients.
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Affiliation(s)
- Chao-Tsung Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Traditional Chinese Medicine, Taipei City Hospital RenAi Branch, Taipei, Taiwan
- General Education Center, University of Taipei, Taipei, Taiwan
| | - Tzu-Wei Huang
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Yi-Sheng Chou
- Department of Medicine, Division of Hematology and Oncology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chi-Feng Cheng
- Department of Medicine, Division of Hematology and Oncology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Hung-Bo Wu
- Department of Medicine, Division of Hematology and Oncology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Branch of Linsen and Chinese Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Hsin Hsiu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
- Biomedical Engineering Research Center, National Defense Medical Center, Taipei, Taiwan
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25
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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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Clinical Significance of Ultrasound Elastography and Fibrotic Focus and Their Association in Breast Cancer. J Clin Med 2022; 11:jcm11247435. [PMID: 36556052 PMCID: PMC9783036 DOI: 10.3390/jcm11247435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Ultrasound (US) elastography is an imaging technology that reveals tissue stiffness. This study aimed to investigate whether fibrotic focus (FF) affects elastographic findings in breast cancer, and to evaluate the clinical significance of US elastography and FF in breast cancer. (2) Methods: In this study, 151 patients with breast cancer who underwent surgery were included. Strain elastography was performed and an elasticity scoring system was used to assess the findings. The elasticity scores were classified as negative, equivocal, or positive. FF was evaluated in the surgical specimens. Medical records were reviewed for all patients. (3) Results: Elastographic findings were equivocal in 30 patients (19.9%) and positive in 121 patients (80.1%). FF was present in 68 patients (46.9%). There was no correlation between elastographic findings and FF. Older age, larger tumor size, lymph node metastasis, and higher tumor stage were associated with positive elastographic results. FF showed a positive correlation with age, postmenopausal status, tumor size, lymphovascular invasion, lymph node metastasis, tumor stage, and intratumoral and peritumoral inflammation. (4) Conclusions: Our study showed that positive elastographic results and FF were associated with poor prognostic factors for breast cancer. FF did not affect the elastographic findings of this study.
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Deng B, Zhao Z, Kong W, Han C, Shen X, Zhou C. Biological role of matrix stiffness in tumor growth and treatment. J Transl Med 2022; 20:540. [PMID: 36419159 PMCID: PMC9682678 DOI: 10.1186/s12967-022-03768-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
In recent years, the biological role of changes in physical factors in carcinogenesis and progression has attracted increasing attention. Matrix stiffness, also known as ECM stress, is a critical physical factor of tumor microenvironment and remains alternating during carcinogenesis as a result of ECM remodeling through activation of cancer-associated fibroblasts and extracellular collagen accumulation, crosslinking and fibrosis. Different content and density of extracellular collagen in ECM endows matrix with varying stiffness. Physical signals induced by matrix stiffness are transmitted to tumor cells primarily by the integrins receptor family and trigger a series of mechanotransduction that result in changes in tumor cell morphology, proliferative capacity, and invasive ability. Importantly, accumulating evidence revealed that changes in matrix stiffness in tumor tissues greatly control the sensitivity of tumor cells in response to chemotherapy, radiotherapy, and immunotherapy through integrin signaling, YAP signaling, and related signaling pathways. Here, the present review analyzes the current research advances on matrix stiffness and tumor cell behavior with a view to contributing to tumor cell growth and treatment, with the hope of improving the understanding of the biological role of matrix stiffness in tumors.
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Affiliation(s)
- Boer Deng
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China ,grid.10698.360000000122483208Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Ziyi Zhao
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China ,grid.10698.360000000122483208Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Weimin Kong
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China ,grid.10698.360000000122483208Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Chao Han
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
| | - Xiaochang Shen
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China ,grid.10698.360000000122483208Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Chunxiao Zhou
- grid.10698.360000000122483208Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA ,grid.10698.360000000122483208Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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Lee Y, Bae SJ, Eun NL, Ahn SG, Jeong J, Cha YJ. Correlation of Yes-Associated Protein 1 with Stroma Type and Tumor Stiffness in Hormone-Receptor Positive Breast Cancer. Cancers (Basel) 2022; 14:cancers14204971. [PMID: 36291755 PMCID: PMC9599900 DOI: 10.3390/cancers14204971] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary YAP1 is an oncogene that can be activated by matrix stiffness, as it can act as a mechanotransducer. So far, only in vitro studies regarding YAP1 activation and matrix stiffness are present. We confirmed the activation of YAP1 in breast cancer using human breast cancer tissue and immunohistochemistry. Tumor stiffness was quantified by shear-wave elastography. Nuclear localization of YAP1 showed correlation with tumor stiffness in hormone-receptor positive (HR+) breast cancer. Also, tumors with non-collagen-type stroma showed an association between YAP1 expression and tumor stiffness. YAP1 expression, along with tumor stiffness, may serve as a prognostic candidate in HR+ breast cancer. Abstract (1) Background: Yes-associated protein 1 (YAP1) is an oncogene activated under the dysregulated Hippo pathway. YAP1 is also a mechanotransducer that is activated by matrix stiffness. So far, there are no in vivo studies on YAP1 expression related to stiffness. We aimed to investigate the association between YAP1 activation and tumor stiffness in human breast cancer samples, using immunohistochemistry and shear-wave elastography (SWE). (2) Methods: We included 488 patients with treatment-naïve breast cancer. Tumor stiffness was measured and the mean, maximal, and minimal elasticity values and elasticity ratios were recorded. Nuclear YAP1 expression was evaluated by immunohistochemistry and tumor-infiltrating lymphocytes (TILs); tumor-stroma ratio (TSR) and stroma type of tumors were also evaluated. (3) Results: Tumor stiffness was higher in tumors with YAP1 positivity, low TILs, and high TSR and was correlated with nuclear YAP1 expression; this correlation was observed in hormone receptor positive (HR+) tumors, as well as in tumors with non-collagen-type stroma. (4) Conclusions: We confirmed the correlation between nuclear YAP1 expression and tumor stiffness, and nuclear YAP1 expression was deemed a prognostic candidate in HR+ tumors combined with SWE-measured tumor stiffness.
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Affiliation(s)
- Yangkyu Lee
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Soong June Bae
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Na Lae Eun
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Sung Gwe Ahn
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Joon Jeong
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
- Institute of Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
- Correspondence: ; Tel.: +82-2-2019-3540
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Parasaram V, Civale J, Bamber JC, Robinson SP, Jamin Y, Harris E. Preclinical Three-Dimensional Vibrational Shear Wave Elastography for Mapping of Tumour Biomechanical Properties In Vivo. Cancers (Basel) 2022; 14:4832. [PMID: 36230755 PMCID: PMC9564290 DOI: 10.3390/cancers14194832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/06/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Preclinical investigation of the biomechanical properties of tissues and their treatment-induced changes are essential to support drug-discovery, clinical translation of biomarkers of treatment response, and studies of mechanobiology. Here we describe the first use of preclinical 3D elastography to map the shear wave speed (cs), which is related to tissue stiffness, in vivo and demonstrate the ability of our novel 3D vibrational shear wave elastography (3D-VSWE) system to detect tumour response to a therapeutic challenge. We investigate the use of one or two vibrational sources at vibrational frequencies of 700, 1000 and 1200 Hz. The within-subject coefficients of variation of our system were found to be excellent for 700 and 1000 Hz and 5.4 and 6.2%, respectively. The relative change in cs measured with our 3D-VSWE upon treatment with an anti-vascular therapy ZD6126 in two tumour xenografts reflected changes in tumour necrosis. U-87 MG drug vs vehicle: Δcs = −24.7 ± 2.5 % vs 7.5 ± 7.1%, (p = 0.002) and MDA-MB-231 drug vs vehicle: Δcs = −12.3 ± 2.7 % vs 4.5 ± 4.7%, (p = 0.02). Our system enables rapid (<5 min were required for a scan length of 15 mm and three vibrational frequencies) 3D mapping of quantitative tumour viscoelastic properties in vivo, allowing exploration of regional heterogeneity within tumours and speedy recovery of animals from anaesthesia so that longitudinal studies (e.g., during tumour growth or following treatment) may be conducted frequently.
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Affiliation(s)
| | | | | | | | | | - Emma Harris
- Division of Radiotherapy and Imaging, Centre for Cancer Imaging, Institute of Cancer Research, London SM2 5NG, UK
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30
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Ventura C, Baldassarre S, Cerimele F, Pepi L, Marconi E, Ercolani P, Floridi C, Argalia G, Goteri G, Giovagnoni A. 2D shear wave elastography in evaluation of prognostic factors in breast cancer. Radiol Med 2022; 127:1221-1227. [DOI: 10.1007/s11547-022-01559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
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Value of shear wave elasticity in predicting the efficacy of neoadjuvant chemotherapy in different molecular types. Clin Imaging 2022; 89:97-103. [DOI: 10.1016/j.clinimag.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
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Agarwal D, Bhatia A, Saxena AK, Dayal D, Sodhi KS. Role of Shear Wave Elastography of Thyroid Gland in Children With Newly Diagnosed Hashimoto's Thyroiditis: Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2217-2225. [PMID: 34862654 DOI: 10.1002/jum.15903] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The data on the use of shear wave elastography (SWE) in children with thyroid disorders is limited. We aimed to assess the role of SWE in the evaluation of the thyroid gland in children newly diagnosed with Hashimoto's thyroiditis (HT). METHODS The thyroid gland was evaluated in 18 children (5 boys and 13 girls, age range: 5-12 years) with newly diagnosed HT and 27 (21 boys and 6 girls, age range: 4-12 years) healthy controls using grayscale ultrasound followed by SWE. The values of SWE (in kPa) were compared between cases and controls and were also correlated with various demographic variables and serum thyroid hormone concentrations. RESULTS The overall median of SWE values in cases and controls was 20.6 kPa (IQR = 19.16-26.94) and 10.7 kPa (IQR = 9.9-16.32), respectively, and the difference was statistically significant (W = 438.5, P < .001). There was a moderate positive correlation between serum triiodothyronine concentrations and SWE (ρ = 0.57, P = .016) and a moderate negative correlation between serum thyroid stimulating hormone concentrations and SWE (ρ = -0.54, P = .020). A significant difference (W = 61.0, P = .003) was also seen in median SWE of the thyroid gland between boys (median: 29.63 kPa, IQR = 27.53-32.88) and girls (median: 19.43 kPa, IQR = 18.88-21.32). CONCLUSION There is a significant difference between SWE values of thyroid in normal children and children with newly diagnosed HT. Hence, SWE may be used as a noninvasive imaging technique in distinguishing normal and abnormal thyroid gland at an early stage. We suggest larger studies to confirm our preliminary findings of SWE in pediatric HT.
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Affiliation(s)
- Divij Agarwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay K Saxena
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Dayal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cui YY, He NA, Ye XJ, Hu L, Xie L, Zhong W, Zhang CX. Evaluation of Tissue Stiffness Around Lesions by Sound Touch Shear Wave Elastography in Breast Malignancy Diagnosis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1672-1680. [PMID: 35672199 DOI: 10.1016/j.ultrasmedbio.2022.04.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/09/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study described here was to assess the evaluation of tissue stiffness around lesions by sound touch shear wave elastography (STE) in breast malignancy diagnosis. This was an institutional ethics committee-approved, single-center study. A total of 90 women with breast masses examined with conventional ultrasound and STE were eligible for enrollment from December 2020 to July 2021. The maximum and mean elastic values of masses, Emax and Emean, were determined. Shell function was used to measure the maximum and mean elastic values of tissues around masses in annular shells 0.5, 1.0, 1.5 and 2.0 mm wide, recorded as corresponding Emax-shell and Emean-shell. All parameters were analyzed and compared with histopathologic results. Receiver operating characteristic curves were constructed to assess diagnostic performance. Logistic regression analysis was conducted to determine the best diagnostic model. Collagen fiber content of tissues around breast lesions was evaluated using Masson staining and ImageJ software. Ninety women with breast masses were included in this study; 50 had benign (mean diameter 15.84 ± 4.39 mm) and 40 had malignant (mean diameter 17.40 ± 5.42 mm) masses. The diagnostic value of Emax-shell-2.0 was the highest (area under the curve = 0.930) with a sensitivity of 87.5% and specificity of 88%. According to stepwise logistic regression analysis, Emax-shell-2.0 and age were independent predictors of malignancy. Emax-shell-2.0 was also found to be highly correlated with the collagen fiber content of tissue in the malignant group (r = 0.877). Tissue stiffness around lesions measured by STE is a useful metric in identifying malignant breast masses by reflecting collagen fiber content, and Emax-shell-2.0 performs best.
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Affiliation(s)
- Ya-Yun Cui
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Nian-An He
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xian-Jun Ye
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lei Hu
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Li Xie
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wen Zhong
- Department of Pathology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chao-Xue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Li H, Bhatt M, Qu Z, Zhang S, Hartel MC, Khademhosseini A, Cloutier G. Deep learning in ultrasound elastography imaging: A review. Med Phys 2022; 49:5993-6018. [PMID: 35842833 DOI: 10.1002/mp.15856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 02/04/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022] Open
Abstract
It is known that changes in the mechanical properties of tissues are associated with the onset and progression of certain diseases. Ultrasound elastography is a technique to characterize tissue stiffness using ultrasound imaging either by measuring tissue strain using quasi-static elastography or natural organ pulsation elastography, or by tracing a propagated shear wave induced by a source or a natural vibration using dynamic elastography. In recent years, deep learning has begun to emerge in ultrasound elastography research. In this review, several common deep learning frameworks in the computer vision community, such as multilayer perceptron, convolutional neural network, and recurrent neural network are described. Then, recent advances in ultrasound elastography using such deep learning techniques are revisited in terms of algorithm development and clinical diagnosis. Finally, the current challenges and future developments of deep learning in ultrasound elastography are prospected. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hongliang Li
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada.,Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
| | - Manish Bhatt
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Zhen Qu
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Shiming Zhang
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Martin C Hartel
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Ali Khademhosseini
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada.,Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada.,Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
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Mahadevan GSV, Chakkalakkoombil SV, Kayal S, Dharanipragada K, Toi PC, Ananthakrishnan R. Evaluation of change in tumor stiffness measured by acoustic radiation force impulse imaging for early prediction of response to neoadjuvant chemotherapy in breast cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:666-674. [PMID: 35353384 DOI: 10.1002/jcu.23201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES In this study, the role of change in tumor stiffness between pre- and post-two cycles of neoadjuvant chemotherapy (NACT) measured by Acoustic Radiation Force Impulse (ARFI) imaging for predicting the response to NACT in breast cancer was analyzed. METHODS Fifty-two adult women with biopsy-proven locally advanced breast cancer and early-stage breast cancer who received NACT followed by either modified radical mastectomy or breast conservation surgery were included in the study. Tumor stiffness represented by shear wave velocity (SWV) in meter per second by ARFI imaging was measured before and after two cycles of NACT. Participants were categorized into responders and nonresponders based on pathological response assessment from the postoperative specimen. The association of change in tumor stiffness between pre- and post-two cycles of NACT with final pathological response status was assessed. RESULTS The mean change in SWV before and after completion of two cycles of NACT was 0.42 ± 0.16 and 0.17 ± 0.11 m/s in responders and nonresponders, respectively, and this difference was proven to be statistically significant (p < 0.001) suggesting that tumors that exhibit a larger reduction in tumor stiffness, respond better. An SWV reduction cut-off of 0.295 m/s between baseline and post-two cycles of NACT was also arrived at, which can discriminate between responders and nonresponders with a sensitivity and specificity of 88% and 83%, respectively. CONCLUSION Difference in tumor stiffness measured by ARFI imaging before and after two cycles of chemotherapy can be used as a reliable early predictor of response to chemotherapy in breast cancer.
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Affiliation(s)
| | | | - Smita Kayal
- Department of Medical Oncology, JIPMER, Pondicherry, India
| | | | - Pampa Ch Toi
- Department of Pathology, JIPMER, Pondicherry, India
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Zhang H, Dong Y, Jia X, Zhang J, Li Z, Chuan Z, Xu Y, Hu B, Huang Y, Chang C, Xu J, Dong F, Xia X, Wu C, Hu W, Wu G, Li Q, Chen Q, Deng W, Jiang Q, Mou Y, Yan H, Xu X, Yan H, Zhou P, Shao Y, Cui L, He P, Qian L, Liu J, Shi L, Zhao Y, Xu Y, Song Y, Zhan W, Zhou J. Comprehensive Risk System Based on Shear Wave Elastography and BI-RADS Categories in Assessing Axillary Lymph Node Metastasis of Invasive Breast Cancer—A Multicenter Study. Front Oncol 2022; 12:830910. [PMID: 35359391 PMCID: PMC8960926 DOI: 10.3389/fonc.2022.830910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/14/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose To develop a risk stratification system that can predict axillary lymph node (LN) metastasis in invasive breast cancer based on the combination of shear wave elastography (SWE) and conventional ultrasound. Materials and Methods A total of 619 participants pathologically diagnosed with invasive breast cancer underwent breast ultrasound examinations were recruited from a multicenter of 17 hospitals in China from August 2016 to August 2017. Conventional ultrasound and SWE features were compared between positive and negative LN metastasis groups. The regression equation, the weighting, and the counting methods were used to predict axillary LN metastasis. The sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUC) were calculated. Results A significant difference was found in the Breast Imaging Reporting and Data System (BI-RADS) category, the “stiff rim” sign, minimum elastic modulus of the internal tumor and peritumor region of 3 mm between positive and negative LN groups (p < 0.05 for all). There was no significant difference in the diagnostic performance of the regression equation, the weighting, and the counting methods (p > 0.05 for all). Using the counting method, a 0–4 grade risk stratification system based on the four characteristics was established, which yielded an AUC of 0.656 (95% CI, 0.617–0.693, p < 0.001), a sensitivity of 54.60% (95% CI, 46.9%–62.1%), and a specificity of 68.99% (95% CI, 64.5%–73.3%) in predicting axillary LN metastasis. Conclusion A 0–4 grade risk stratification system was developed based on SWE characteristics and BI-RADS categories, and this system has the potential to predict axillary LN metastases in invasive breast cancer.
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Affiliation(s)
- Huiting Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohong Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhiyao Li
- Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhirui Chuan
- Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjun Xu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Bin Hu
- Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai, China
| | - Yunxia Huang
- 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
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, and The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, and The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xiaona Xia
- Department of Ultrasound Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chengrong Wu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wenjia Hu
- Department of Ultrasound, People’s Hospital of Henan Province, Zhengzhou, China
| | - Gang Wu
- Department of Ultrasound, People’s Hospital of Henan Province, Zhengzhou, China
| | - Qiaoying Li
- Department of Ultrasound Diseases, Tangdu Hospital, Four Military Medical University, Xi’an, China
| | - Qin Chen
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wanyue Deng
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiongchao Jiang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonglin Mou
- Department of Ultrasound, General Hospital of Northern Theater Command, Shenyang, China
| | - Huannan Yan
- Department of Ultrasound, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaojing Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongju Yan
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yang Shao
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jinping Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liying Shi
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Yanan Zhao
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yongyuan Xu
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yanyan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
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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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Association of Tumor Strain Ratio with Prognostic Factors in Invasive Breast Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Evaluation of Multiparametric Shear Wave Elastography Indices in Malignant and Benign Breast Lesions. Acad Radiol 2022; 29 Suppl 1:S50-S61. [PMID: 34674923 DOI: 10.1016/j.acra.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the shear wave elastography indices (multiparametric SWE) of breast lesions based on patient and lesion dependent features and assess the contribution of different elastographic parameters to radiological diagnosis. MATERIALS AND METHODS Effect of patient-dependent (age and menopausal status) and lesion-dependent (distance from the areola, quadrant location, size, depth, margin and shape) factors on SWE parameters (Vmean, Vsd, Vmax, Vmin) in benign breast lesions were assessed. Only mass lesions were included in the study. Sensitivity, specificity, PPV, NPV and cut-off values for each elastography parameter was calculated. RESULTS A total of 496 mass lesions of breast were evaluated. 467 of the lesions were benign and 29 were malignant. There was no significant relationship among SWE indices and age, menopausal status, lesion shape and distance to the areola in benign lesions (p>0.05). SWE indices were found to be associated with lesion margin, depth from the skin, and lesion size in benign lesions (p<0.05). All BI-RADS 3 lesions that underwent biopsy were benign (n:35); 23.5% of 4a lesions were malignant (n:4/17) and all 4b-4c-5 lesions were malignant (n:25/25). The cut-off values for malignant lesions were: Vmean 3.38 m/s, Vsd 0.81, Vmax 6.87 m/s, Vmin 1.53 m/s. All SWE parameters were statistically significant in predicting malignancy on ROC analysis, Vmax was the most sensitive (96.3%) and specific (94.7%) parameter. Cut-off values for Vmax was 6.87 m/s with an accuracy rate of 94.7%, and 3.37 m/s for Vmean and 0.8 for Vsd with 92.5% accuracy. CONCLUSION The SWE parameters to predict malignancy in breast lesions can be affected by lesion dependent features, whereas no significant effect of patient's age or menopausal status on stiffness of the lesions was observed. Vmax had the highest sensitivity for predicting malignancy.
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Min X, Zhu J, Shang M, Liu J, Zhang K, Guo L, Li L, Cheng L, Li J. Stiffness Could be a Predictor of AJCC Prognostic Stage Groups in Preoperative Invasive Ductal Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2665-2674. [PMID: 33629753 DOI: 10.1002/jum.15657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/23/2021] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aimed to evaluate the stiffness of 2-dimensional (2D) shear wave elastography (SWE) in preoperatively predicting the prognostic stage groups of invasive ductal carcinoma (IDC). METHODS Eighty-six newly diagnosed lesions on 83 patients with IDCs were analyzed. All parameters from conventional ultrasound and stiffness to virtual touch tissue imaging and quantification were collected, and mean shear wave velocity (SWVmean) was calculated. Data on maximum diameter, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), histologic grading system and Tumor Node Metastasis (TNM) stages were collected. The levels of maximum shear wave velocity (SWVmax), minimum shear wave velocity (SWVmin) and SWVmean were compared. In receiver operating characteristic (ROC) curves analysis, the diagnostic efficacy was found in area under the curve (AUC). Parallel mode was used to improve the predictive value of sensitivity. RESULTS The median stiffness of SWVmax and SWVmean for IDCs were 9.38 and 6.32 m/s for late stage (stages II, III, IV) and 6.39 m/s and 4.72 m/s for early stage (stage I) of the prognostic stage groups, respectively. The median stiffness values in the late stage were significantly higher than those in the early stage (P = .003, P = .005). The optimal cutoff stiffness of SWVmax and SWVmean were 8.62 and 6.13 m/s, respectively. In ROC curves analysis, the AUC for SWVmax was 0.742, and it showed a better diagnostic value than SWVmean (0.725). In predictive diagnosis, the sensitivity for SWVmax and SWVmean were both 62.50%. The parallel mode improved the prediction power of sensitivity to 68.75%. CONCLUSIONS Preoperative SWV level may serve as a promising prognostic imaging indicator for breast IDCs.
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Affiliation(s)
- Xiang Min
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Health Management Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiang Zhu
- Department of Breast Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mengmeng Shang
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jikai Liu
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kai Zhang
- Department of Breast Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lu Guo
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Li
- Department of Ultrasound, Medical Section, Jinan Maternal and Child Health Hospital, Jinan, China
| | - Lin Cheng
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jie Li
- Department of Ultrasound, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Takaya Y, Nakamura K, Nakayama R, Ohtsuka H, Amioka N, Kondo M, Akazawa K, Ohno Y, Ichikawa K, Saito Y, Akagi S, Yoshida M, Miyoshi T, Ito H. Efficacy of shear wave elasticity for evaluating myocardial hypertrophy in hypertensive rats. Sci Rep 2021; 11:22812. [PMID: 34819579 PMCID: PMC8613270 DOI: 10.1038/s41598-021-02271-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
Shear wave (SW) imaging is a novel ultrasound-based technique for assessing tissue characteristics. SW elasticity may be useful to assess the severity of hypertensive left ventricular (LV) hypertrophy. This study aimed to evaluate the efficacy of SW elasticity for assessing the degree of myocardial hypertrophy using hypertensive rats. Rats were divided into hypertension group and control group. SW elasticity was measured on the excised heart. Myocardial hypertrophy was assessed histologically. LV weight was greater in hypertension group. An increase in interventricular septum and LV free wall thicknesses was observed in hypertension group. SW elasticity was significantly higher in hypertension group than in control group (14.6 ± 4.3 kPa vs. 6.5 ± 1.1 kPa, P < 0.01). The cross-sectional area of cardiomyocytes was larger in hypertension group than in control group (397 ± 50 μm2 vs. 243 ± 14 μm2, P < 0.01), and SW elasticity was positively correlated with the cross-sectional area of cardiomyocytes (R = 0.96, P < 0.01). This study showed that SW elasticity was higher in hypertensive rats and was closely correlated with the degree of myocardial hypertrophy, suggesting the efficacy of SW elasticity for estimating the severity of hypertensive LV hypertrophy.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroaki Ohtsuka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Naofumi Amioka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Megumi Kondo
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kaoru Akazawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuko Ohno
- Kawasaki University of Medical Welfare, Okayama, Japan
| | - Keishi Ichikawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yukihiro Saito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masashi Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Leng X, Japaer R, Zhang H, Yeerlan M, Ma F, Ding J. Relationship of shear wave elastography anisotropy with tumor stem cells and epithelial-mesenchymal transition in breast cancer. BMC Med Imaging 2021; 21:171. [PMID: 34789199 PMCID: PMC8600915 DOI: 10.1186/s12880-021-00707-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background This study is to examine the feasibility of shear wave elastography (SWE) anisotropy in assessing the prognosis of breast cancer. Methods We enrolled 119 breast cancer patients from January 2017 to October 2019. SWE was performed before operation. Emax (maximum elasticity value), Emean (average elasticity value), Esd (standard deviation of the lesion elasticity value), Eratio (elasticity value of adipose tissue), anisotropy coefficient and difference were recorded. After operation, we collected clinical pathological data, and performed immunohistochemistry and real-time PCR tests on CD44, CD24, E-cadherin, β-catenin, vimentin and N-cadherin. Finally, we analyzed the correlation among parameters of SWE, anisotropy and clinicopathology, and markers of CSCs (cancer stem cells) and EMT (epithelial-mesenchymal transition). Results Emax, Emean and Esd of the cross section were higher than those of the longitudinal section. Breast cancer with a higher elastic modulus was often accompanied by a hyperechoic halo, which was manifested as mixed echo and post-echo attenuation, and was accompanied by a higher BI-RADS (breast imaging reporting and data system) classification. When breast cancer had hyperechoic halo and weakened posterior echo, SWE of the lesion showed more obvious anisotropy. In addition, larger diameter of the longitudinal section indicated higher stiffness of the cross section. Correlation analysis showed that E-cadherin was negatively correlated with SWE in longitudinal section. CD44, N-cadherin, β-catenin were positively correlated with SWE in longitudinal and cross sections. Vimentin and CD24 had no correlation with SWE parameters. Conclusion SWE of breast cancer is anisotropic. The cross-sectional SWE is better than the longitudinal SWE, Emax is better than Emean, the anisotropy of SWE is better than SWE, and the anisotropy factor is better than the anisotropy difference.
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Affiliation(s)
- Xiaoling Leng
- Department of Ultrasound, Affiliated Tumor Hospital of Xinjiang Medical University, No. 789 Suzhou East Road, Xinshi District, Urumqi, 830011, People's Republic of China
| | - Rexida Japaer
- Department of Ultrasound, Affiliated Tumor Hospital of Xinjiang Medical University, No. 789 Suzhou East Road, Xinshi District, Urumqi, 830011, People's Republic of China
| | - Haijian Zhang
- Department of Ultrasound, Affiliated Tumor Hospital of Xinjiang Medical University, No. 789 Suzhou East Road, Xinshi District, Urumqi, 830011, People's Republic of China
| | - Mila Yeerlan
- Department of Ultrasound, Affiliated Tumor Hospital of Xinjiang Medical University, No. 789 Suzhou East Road, Xinshi District, Urumqi, 830011, People's Republic of China
| | - Fucheng Ma
- Department of Ultrasound, Affiliated Tumor Hospital of Xinjiang Medical University, No. 789 Suzhou East Road, Xinshi District, Urumqi, 830011, People's Republic of China.
| | - Jianbing Ding
- Department of Ultrasound, Affiliated Tumor Hospital of Xinjiang Medical University, No. 789 Suzhou East Road, Xinshi District, Urumqi, 830011, People's Republic of China. .,School of Basic Medicine, Xinjiang Medical University, No. 567 Shangde North Road, Urumqi, 830017, Xinjiang, People's Republic of China.
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Huang Y, Liu Y, Wang Y, Zheng X, Han J, Li Q, Hu Y, Mao R, Zhou J. Quantitative analysis of shear wave elastic heterogeneity for prediction of lymphovascular invasion in breast cancer. Br J Radiol 2021; 94:20210682. [PMID: 34478333 DOI: 10.1259/bjr.20210682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between elastic heterogeneity (EH) and lymphovascular invasion (LVI) in breast cancers and assess the clinical value of using EH to predict LVI pre-operatively. METHODS This retrospective study consisted of 376 patients with breast cancers that had undergone shear wave elastography (SWE) with virtual touch tissue imaging quantification between June 2017 and June 2018. The EH was determined as the difference between the averaged three highest and three lowest shear wave value. Clinicalpathological parameters including histological type and grades, LVI, axillary lymph node status and molecular markers (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 and Ki-67) were reviewed and recorded. Relationship EH and clinicalpathological parameters was investigated respectively. The diagnostic performance of EH in distinguishing LVI or not was analyzed. RESULTS At multivariate regression analysis, only EH (p = 0.017) was positively correlated with LVI in all tumors. EH (p = 0.003) and Ki-67 (p = 0.025) were positively correlated with LVI in tumors ≤ 2 cm. None of clinicalpathological parameters were correlated with LVI in tumors > 2 cm (p > 0.05 for all). Using EH to predict LVI in tumors ≤ 2 cm, the sensitivity and negative predictive value were 93 and 89% respectively. CONCLUSION EH has the potential to be served as an imaging biomarker to predict LVI in breast cancer especially for tumors ≤ 2 cm. ADVANCES IN KNOWLEDGE There was no association between LVI and other most commonly used elastic features such as SWVmean and SWVmax. Elastic heterogeneity is an independent predictor of LVI, so it can provide additional prognostic information for routine preoperative breast cancer assessment.For tumors ≤ 2cm, using EH value higher than 1.36 m/s to predict LVI involvement, the sensitivity and negative predictive value can reach to 93% and 89%, respectively, suggesting that breast cancer with negative EH value was more likely to be absent of LVI.
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Affiliation(s)
- 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, Guangdong, China
| | - 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, Guangdong, China
| | - Yun Wang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong, China
| | - Xueyi Zheng
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong, 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, Guangdong, China
| | - Qian Li
- Department of Ultrasound, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Yixin Hu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong, China
| | - Rushuang Mao
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong, 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, Guangdong, China
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Wang J, Chu Y, Wang B, Jiang T. A Narrative Review of Ultrasound Technologies for the Prediction of Neoadjuvant Chemotherapy Response in Breast Cancer. Cancer Manag Res 2021; 13:7885-7895. [PMID: 34703310 PMCID: PMC8523361 DOI: 10.2147/cmar.s331665] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/29/2021] [Indexed: 12/21/2022] Open
Abstract
The incidence and mortality rate of breast cancer (BC) in women currently ranks first worldwide, and neoadjuvant chemotherapy (NAC) is widely used in patients with BC. A variety of imaging assessment methods have been used to predict and evaluate the response to NAC. Ultrasound (US) has many advantages, such as being inexpensive and offering a convenient modality for follow-up detection without radiation emission. Although conventional grayscale US is typically used to predict the response to NAC, this approach is limited in its ability to distinguish viable tumor tissue from fibrotic scar tissue. Contrast-enhanced ultrasound (CEUS) combined with a time-intensity curve (TIC) not only provides information on blood perfusion but also reveals a variety of quantitative parameters; elastography has the potential capacity to predict NAC efficiency by evaluating tissue stiffness. Both CEUS and elastography can greatly improve the accuracy of predicting NAC responses. Other US techniques, including three-dimensional (3D) techniques, quantitative ultrasound (QUS) and US-guided near-infrared (NIR) diffuse optical tomography (DOT) systems, also have advantages in assessing NAC response. This paper reviews the different US technologies used for predicting NAC response in BC patients based on the previous literature.
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Affiliation(s)
- Jing Wang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Yanhua Chu
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Baohua Wang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Tianan Jiang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
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Mberu V, McFarlane J, Macaskill EJ, Evans A. A retrospective review of MRI features associated with metastasis-free survival in women with breast cancer: focusing on skin thickening and skin enhancement. Br J Radiol 2021; 94:20210472. [PMID: 34591686 DOI: 10.1259/bjr.20210472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To identify associations between MRI-detected skin thickening and enhancement and metastasis-free survival (MFS) given recent reports of skin thickening on ultrasound being a poorer prognostic indicator. METHODS Interrogation of a prospectively collected database of ultrasound-visible breast lesions showed 214 lesions with pre-treatment MRIs available for analysis in a single centre. Data on MFS was prospectively collected. Retrospective MRI review was performed blinded to outcome. Imaging factors recorded were presence of skin thickening and enhancement, non-mass-enhancement (NME) and abnormal nodes, mass characteristics, perilesional oedema and background parenchymal enhancement. Statistical analysis used chi-squared test, Kaplan-Meier survival curves, the Log-rank test and receiver-operator characteristic (ROC) curves. RESULTS During a median follow-up period of 5.6 years, 21 (10%) of 212 patients developed distant metastases. Skin thickening [24 of 30 (80%) vs 169 of 184 (92%), p = 0.043] and skin enhancement [15 of 20 (75%) vs 178 of 194 (92%), p = 0.016] were associated with poorer MFS. Large index lesion size [p < 0.001, AUC 0.823], large sum of masses [p < 0.001, AUC 0.813], increasing total lesion extent including NME [p < 0.001, AUC 0.749] and abnormal axillary nodes [55 of 66 (83%) vs 138 of 148 (93%), p = 0.024] were also associated with poorer MFS. CONCLUSIONS Skin thickening and enhancement on breast MRI are associated with poorer MFS. These findings should be taken into account when managing patients with invasive breast cancer. ADVANCES IN KNOWLEDGE Skin enhancement on breast MRI at diagnosis is associated with metastases development. Skin thickening on breast MRI is associated with future metastatic disease.
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Affiliation(s)
- Valentine Mberu
- University of Dundee, School of Medicine, Ninewells Hospital, Dundee, UK
| | | | | | - Andrew Evans
- University of Dundee, School of Medicine, Ninewells Hospital, Dundee, UK
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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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Keller SB, Averkiou MA. The Role of Ultrasound in Modulating Interstitial Fluid Pressure in Solid Tumors for Improved Drug Delivery. Bioconjug Chem 2021; 33:1049-1056. [PMID: 34514776 DOI: 10.1021/acs.bioconjchem.1c00422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The unique microenvironment of solid tumors, including desmoplasia within the extracellular matrix, enhanced vascular permeability, and poor lymphatic drainage, leads to an elevated interstitial fluid pressure which is a major barrier to drug delivery. Reducing tumor interstitial fluid pressure is one proposed method of increasing drug delivery to the tumor. The goal of this topical review is to describe recent work using focused ultrasound with or without microbubbles to modulate tumor interstitial fluid pressure, through either thermal or mechanical effects on the extracellular matrix and the vasculature. Furthermore, we provide a review on techniques in which ultrasound imaging may be used to diagnose elevated interstitial fluid pressure within solid tumors. Ultrasound-based techniques show high promise in diagnosing and treating elevated interstitial pressure to enhance drug delivery.
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Affiliation(s)
- Sara B Keller
- Department of Bioengineering, University of Washington, Seattle, Washington 98195, United States
| | - Michalakis A Averkiou
- Department of Bioengineering, University of Washington, Seattle, Washington 98195, United States
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Evans A, Sim YT, Whelehan P, Savaridas S, Jordan L, Thompson A. Are baseline mammographic and ultrasound features associated with metastasis free survival in women receiving neoadjuvant chemotherapy for invasive breast cancer? Eur J Radiol 2021; 141:109790. [PMID: 34091135 DOI: 10.1016/j.ejrad.2021.109790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To identify associations between baseline ultrasound (US) and mammographic features and metastasis free survival (MFS) in women receiving neo-adjuvant chemotherapy (NACT) for breast cancer. METHODS The data were collected as part of an ethically approved prospective study. Women with invasive breast cancer receiving NACT who were metastasis free at diagnosis were included. Baseline US and mammography were performed. Imaging was assessed by an experienced breast radiologist who was blinded to outcomes. US imaging features documented included posterior effect, skin thickening, size and stiffness using shear wave elastography (SWE). The mammographic features documented were spiculation and microcalcification. The development of metastatic disease was ascertained from computer records. Statistical analysis was performed using Kaplan Meier survival curves and Receiver Operator Characteristic (ROC) analysis. RESULTS 171 women with 172 cancers were included in the study and 55 developed metastatic disease. Mean follow-up was 6.0 years. Women with mammographic calcification had significantly poorer metastasis free survival (MFS) compared to women without calcification (p = 0.043, 6 yr MFS 50 % vs 69 %). Women bearing cancer with distal shadowing had poorer MFS than women without shadowing (p = 0.025, 6 yr MFS 47 % vs. 73 %). Women with US skin thickening had poorer MFS compared to women without skin thickening (p = 0.032, 6 yr MFS 52 % vs. 68 %). Mammographic spiculation, US size and stiffness at SWE had no significant association with MFS. CONCLUSION We have identified mammographic and US features associated with MFS in women receiving NACT. Such information may be useful when counselling patients about the benefits and risks of NACT.
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Affiliation(s)
- Andy Evans
- Mail Box 4, Ninewells Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom.
| | - Yee Ting Sim
- Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Patsy Whelehan
- Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Sarah Savaridas
- Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Lee Jordan
- Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - Alastair Thompson
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, United States
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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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Qin Q, Wang D, Xu L, Lan Y, Tong M. Evaluating Lymph Node Stiffness to Differentiate Bacterial Cervical Lymphadenitis and Lymph Node-First Presentation of Kawasaki Disease by Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1371-1380. [PMID: 33006783 DOI: 10.1002/jum.15518] [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: 07/17/2020] [Revised: 08/27/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The purpose of our study was to evaluate the potential of cervical lymph node shear wave elastography (SWE) to quantify the lymph node stiffness (kilopascals) noninvasively among patients with lymph node-first presentation of Kawasaki disease (NFKD), patients with bacterial cervical lymphadenitis (BCL), and healthy children (HC). We further aimed to investigate the correlation of laboratory data and lymph node stiffness to provide a reference basis for the early diagnosis of NFKD. METHODS Lymph node stiffness measurements were prospectively performed in 47 patients with NFKD, 56 patients with BCL, and 56 HC using SWE. Cervical SWE was compared in the groups. Factors associated with increased cervical lymph node stiffness were studied. RESULTS The mean elasticity of the largest cervical lymph nodes was significantly higher in the BCL group than the NFKD and HC groups (mean elasticity ± SD, 16.37 ± 2.45, 12.22 ± 2.64, and 7.81 ± 1.67 kPa, respectively; P < .01), with a cutoff of 14.55 kPa (area under the curve, 0.885; sensitivity, 89%; and specificity, 76%). In patients with NFKD, interleukin 6 (standardized β = 0.363; P = .01), alanine aminotransferase (standardized β = 0.253; P = .03), aspartate aminotransaminase (standardized β = 0.536; P = .047), and total bilirubin (standardized β = 0.486; P < .01) values were correlated with increased largest cervical lymph node stiffness. CONCLUSIONS Cervical lymph node stiffness was different between NFKD and BCL. Shear wave elastography is a potential method to identify clinically distinguishable early NFKD.
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Affiliation(s)
- Qin Qin
- Lanzhou University Second Hospital, Lanzhou, China
| | - Dandan Wang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Lili Xu
- Lanzhou University Second Hospital, Lanzhou, China
| | - Yuxia Lan
- Lanzhou University Second Hospital, Lanzhou, China
| | - Minghui Tong
- Lanzhou University Second Hospital, Lanzhou, China
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