Evaluating Tumor‐Infiltrating Lymphocytes in Breast Cancer

Abstract

Objectives Tumor‐infiltrating lymphocytes (TILs) have emerged as an efficient biomarker predicting treatment response and prognosis of breast cancer (BC). This study aimed to evaluate the association between conventional ultrasound and contrast‐enhanced ultrasound (CEUS) imaging features with TIL levels in invasive BC patients. Methods We retrospectively included 267 women with invasive BC who had undergone conventional ultrasound and CEUS. Patients were divided into low (≤10%) and high (>10%) TIL groups. Conventional ultrasound and CEUS features were analyzed by two sonographers. The associations between the TIL levels and imaging features were evaluated. Results Of the 267 patients, 122 with high TILs and 145 with low TIL levels. High TIL tumors were more likely to have a circumscribed margin, oval or round shape, and enhanced posterior echoes on ultrasonography (p < 0.05). In contrast, low TIL tumors were more likely to have an irregular shape, un‐circumscribed, indistinct and spiculated margin (p < 0.05). In CEUS, high TIL tumors showed a more regular shape, clearer margin, more homogeneous enhancement and higher peak intensity (PI) value (p < 0.05). Logistic analysis indicated that shape, posterior features, PI, and enhanced homogeneity were independent predictors for high TIL tumors. The model combined the four independent predictors have a moderate performance in predicting high TIL tumors with AUC 0.79, sensitivity 0.72, and specificity 0.78. Conclusions Conventional ultrasound and CEUS features were associated with TIL levels in invasive BC. Consequently, the results suggested that preoperative conventional ultrasound and CEUS may be a useful noninvasive imaging biomarker for individualized treatment decisions.

Radiological Features for Predicting the Status of CD8-Positive Lymphocytes in HER2 Positive Breast Cancer

“…Several studies have demonstrated the effectiveness of US 13 , 14 , 15 , 16 and MRI 1 , 2 , 3 , 4 , 5 , 10 , 11 , 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 in predicting TILs in BC. However, only one study has evaluated TILs in BC in multimodality (US and MRI).…”

“…Previous studies evaluating the relationship between US features and TIL levels found some correlations, such as tumor shape and internal echo. 13 , 14 , 15 , 16 MRI characteristics, such as tumor size, margin, apparent diffusion coefficient (ADC), and enhancement pattern, have been associated with TIL levels of BC. 1 , 2 , 3 , 4 , 5 , 10 , 11 , 14 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 However, no conclusive results were obtained.…”

Tumor infiltrating lymphocytes and radiological picture of the tumor

“…They observed no differences in the size of the tumors between high- and low-TILs groups, and more common circumscribed margins, oval or round shapes and enhanced posterior echoes in the high-TILs group compared to low-TILs one. Moreover, the utilization of CEUS further developed the list of high TILs tumor characteristics—more regular shape, higher homogenous enhancement, clear margin after enhancement, as well as higher intensity peak [ 45 ].…”

“…The differences in characteristics of TILs-rich tumors can possibly be attributed to some important differences in study setups used by each group. Firstly, it is important to note that the authors have adopted different cutoff points for lymphocyte-rich tumors—on the level of 10% [ 44 , 45 ], 20% [ 46 ] or 50% [ 40 , 41 ]. Additionally, an overwhelming majority of study groups [ 40 , 41 , 44 , 45 ] included all breast cancer subtypes and their percentage distributions in high-TILs groups differed significantly.…”

“…Firstly, it is important to note that the authors have adopted different cutoff points for lymphocyte-rich tumors—on the level of 10% [ 44 , 45 ], 20% [ 46 ] or 50% [ 40 , 41 ]. Additionally, an overwhelming majority of study groups [ 40 , 41 , 44 , 45 ] included all breast cancer subtypes and their percentage distributions in high-TILs groups differed significantly. Thus, the most accurate study model seems to be presented by Candelaria et al as they decided to focus only on TNBC cases.…”