BI-RADS 4 breast lesions: could multi-mode ultrasound be helpful for their diagnosis?

Liu, Gang; Zhang, Mengke; He, Yu; Liu, Yuan; Li, Xiru; Wang, Zhili

doi:10.21037/gs.2019.05.01

Cited by 41 publications

(43 citation statements)

References 31 publications

(33 reference statements)

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“…SWE could quantitatively evaluate the elastic characteristics of breast lesions and more accurately judge the benign and malignant breast lesions. Our study showed that there were signi cant differences in elastic characteristics between benign and malignant breast lesions, which were the same as those of previous studies [8,20]. For malignant breast lesions, a large number of cancer cells proliferated, invaded and in ltrated the normal breast stroma and adipose tissue, and interacted with the tumor microenvironment, causing complex connective tissue hyperplasia and brosis, which were important typical pathological changes in the process of tumor development and invasion, they could lead to overexpression and accumulation of ECM components, rearrangement and cross-linking of ECM structure [21,22], and increase the stiffness of the lesions.…”

Section: Discussionsupporting

confidence: 91%

TGF-β1 and Its Signal Transduction Pathways: Are They Corelated With The Elastic Characteristics of Breast Lesions?

Zhang¹,

Li²,

Wang³

et al. 2021

Preprint

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Background: Shear wave elastography (SWE) can evaluate the tissue stiffness. Previous studies showed that the elastic characteristics of breast lesions were related to the components of extracellular matrix (ECM) which was directly or indirectly regulated by transforming growth factor beta 1(TGF-β1). However, it is rarely reported whether there is a correlation between TGF-β1 and the elastic characteristics of breast lesions. The purpose of this study was to investigate the relationship between TGF-β1 with its signal transduction pathways and the elastic characteristics of breast lesions.Methods: 135 breast lesions in 130 patients were included. Before operation or biopsy, SWE was performed. Elastic characteristics such as the maximum, mean, minimum and standard deviation (SD) of elastic modulus (Emax, Emean, Emin, Esd), the elastic ratio of the lesions to the peripheral tissue (Eratio) and the "stiff rim sign" were recorded. The expression levels of TGF-β1, Smad2/3, Erk1/2, p38 MAPK, JNK2, PI3K and AKT were detected by immunohistochemistry. The elastic characteristics and the expression levels of the above-mentioned indexes of benign lesions were were analyzed.Results: Emax, Emean, Esd, Eratio, “stiff rim sign” detection rate and the expression levels of TGF- β 1, et al. of benign were lower than those of malignant lesions (P＜0.0001). The expression levels of TGF- β 1, Smad2/3, Erk1/2, p38 MAPK, JNK2, PI3K and AKT were correlated with Emax, Emean, Esd, Eratio of breast lesions, the expression levels of TGF- β 1, et al. of lesions with “stiff rim sign” were higher than those of lesions without “stiff rim sign” (P＜0.05). And the expression levels of Smad2/3, Erk1/2, p38 MAPK, JNK2, PI3K and AKT were corelated with that of TGF- β 1 (r=0.678, 0.633, 0.645, 0.611, 0.589, 0.663, P＜0.0001).Conclusions: The expression levels of TGF-β1, et al. of breast lesions were corelated with the elastic characteristics, the expression levels of Smad2/3, Erk1/2, p38 MAPK, JNK2, PI3K and AKT were corelated with that of TGF- β 1, which speculated that TGF- β 1 might play an important role in the stiffness regulation of breast lesions through multiple signal transduction pathways.

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Section: Discussionsupporting

confidence: 91%

TGF-β1 and Its Signal Transduction Pathways: Are They Corelated With The Elastic Characteristics of Breast Lesions?

Zhang¹,

Li²,

Wang³

et al. 2021

Preprint

Self Cite

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“…A previous study has con rmed that multi-mode US (US combined with CEUS, SWE) can signi cantly improve the diagnostic e cacy of breast cancer [8]. Similarly, another study has con rmed that CEUS combined with SWE can greatly improve the detection rate of small breast cancer [9].…”

Section: Introductionmentioning

confidence: 97%

Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules

Shen

Liu

et al. 2020

Preprint

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Background: Identification of malignancy in small breast nodules can be difficult using conventional methods, especially in patients with dense breast tissue. Advanced imaging techniques, including contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE), could be used in conjunction with the Breast Imaging Reporting and Data System (BI-RADS) classification to characterize these nodules more effectively. This retrospective study aimed to evaluate the use of CEUS and SWE for the differentiation of benign from malignant small (≤ 2 cm) breast nodules.Methods: We reviewed the medical records and imaging data of 302 patients who underwent evaluation for 305 small breast nodules from November 2015 to December 2019. The BI-RADS classification values of the nodules and the results of CEUS and SWE were retrospectively analyzed; the diagnostic efficacy of these techniques was evaluated by comparison of the pathology results. Receiver operating characteristic (ROC) curves were analyzed based on the CEUS patterns and shear-wave velocity values of the nodules. The sensitivity, specificity, positive and negative predictive values, accuracies of BI-RADS, CEUS, SWE, and a combination of all three methods for identifying benign and malignant small breast nodules were investigated.Results: CEUS was effective at diagnosing malignant nodules when at least two out of nine suspicious features were present. ROC analysis revealed that the best cut-off value for SWE was at 3.7 m/s. For the diagnosis of benign breast nodules, the BI-RADS classification was reduced by one level when both, CEUS and SWE were used, and remained unchanged when either one, CEUS or SWE was used; the highest and lowest levels were of category 5 and 3, respectively. Furthermore, when using the combined method, 75.8% (91/120) of small breast nodules with a BI-RADS category 4A classification avoided the need for coarse needle biopsies.Conclusions: CEUS and SWE can be used as auxiliary methods for clarifying BI-RADS classification of the breast nodules, and a combination of these techniques may provide more diagnostic efficacy for identifying malignancy in small breast nodules.Trial registration: Retrospectively registered.

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“…In addition, lymphangiography revealed decrease in the lymphatic sinus region due to the tumor formation at the early stage of metastasis, i.e., the parenchyma was replaced with tumor cells 25 . Therefore, a perfusion defect in a metastatic LN at an early stage is presumed to be an event that is distinct from those associated with hypoxia, angiogenesis, keratinization and tissue necrosis, which occur as tumor growth rapidly progresses 26,27 . The present study aims to elucidate the mechanisms of perfusion defect formation in the tumor mass in the nonenlarged LN at the early stage of metastasis.…”

Section: Introductionmentioning

confidence: 99%

Formation of Perfusion Defects in Lymph Nodes During the Early Stage of Metastasis 

Yamaki

Sukhbaatar

Kikuchi

et al. 2021

Preprint

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A perfusion defect in metastatic lymph nodes (LNs) can be visualized as a localized area of low contrast on contrast-enhanced CT, MRI or ultrasound images. Hypotheses for perfusion defect include abnormal hemodynamics in neovascular vessels and decrease in blood flow in pre-existing blood vessels in the parenchyma due to compression of tumor growth in the LNs. However, the mechanism of perfusion defects in LNs during the early stage of LN metastasis has not yet been investigated. Here we show that the formation of a tumor mass with very few microvessels was associated with the development of a perfusion defect in the non-enlarged LN at the early stage of LN metastasis. We found in a mouse model of LN metastasis induced using non-keratinizing tumor cells that during formation of the perfusion defect in non-enlarged LN, the number of blood vessels £ 50 mm in diameter decreased, while the volume of existing blood vessels >50 mm in diameter increased using contrast-enhanced high-frequency ultrasound and contrast-enhanced micro-CT imaging systems with a maximum spatial resolution of > 30 mm. Furthermore, we found that tumor angiogenesis and pO2 changes in the metastatic LN were not observed. Our results demonstrate that the perfusion defect appear to be a specific form of tumorigenesis in the LN as vascular-rich organ at the early stage of metastasis. We anticipate a perfusion defect on ultrasound, CT or MRI images to be used as an indicator in the non-enlarged LN at the early stage of LN metastasis.

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BI-RADS 4 breast lesions: could multi-mode ultrasound be helpful for their diagnosis?

Cited by 41 publications

References 31 publications

TGF-β1 and Its Signal Transduction Pathways: Are They Corelated With The Elastic Characteristics of Breast Lesions?

TGF-β1 and Its Signal Transduction Pathways: Are They Corelated With The Elastic Characteristics of Breast Lesions?

Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules

Formation of Perfusion Defects in Lymph Nodes During the Early Stage of Metastasis

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BI-RADS 4 breast lesions: could multi-mode ultrasound be helpful for their diagnosis?

Cited by 41 publications

References 31 publications

TGF-β1 and Its Signal Transduction Pathways: Are They Corelated With The Elastic Characteristics of Breast Lesions?

TGF-β1 and Its Signal Transduction Pathways: Are They Corelated With The Elastic Characteristics of Breast Lesions?

Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules

Formation of Perfusion Defects in Lymph Nodes During the Early Stage of Metastasis&nbsp;

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Formation of Perfusion Defects in Lymph Nodes During the Early Stage of Metastasis