Quantitative and Qualitative Evaluation of Breast Cancer Prognosis: A Sonographic Elastography Study

Abstract

BackgroundBreast cancer is one of the most commonly diagnosed cancers in women worldwide, and sonographic elastography has previously demonstrated good performance in detecting breast malignancies. However, the exact relationship between elastographic measures and clinical prognostic factors is still not well understood. Thus, the aim of this study was to evaluate any associations between major clinical prognostic factors and strain elastography and to validate the diagnostic value of elastography in breast cancer.Material/MethodsA total of 373 subjects with breast masses, of which 196 were benign and 177 were malignant, were included in the study. All subjects underwent routine ultrasound examination and strain elastography before biopsy. The elastographic measures – strain ratio (SR) for qualitative measures and Tsukuba score (TS) for quantitative measures – were obtained and compared with prognostic factors, including nuclear grade, lymph node status, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER-2). The SR demonstrated the best diagnostic performance in differentiation between malignant and benign lesions.ResultsWith the best cut-off value at 2.42, the SR achieved a sensitivity of 96.0% and specificity of 98.5%. Moreover, higher SRs and TSs were associated with breast lesions with a high nuclear grade and lymph node metastasis and with being ER-negative, PR-negative, and HER-2 negative.ConclusionsElastography is a useful imaging technique in differentiating benign breast masses from malignant ones. The strong relationship between prognostic factors and elastographic measures also demonstrated its excellent performance in predicting the prognosis of breast malignancies.

Diagnostic and Predictive Values of Strain Ratios in the Regions of Interests in Reference Tissue for Breast Tumor

“… 43 , 44 In a murine model, Chamming’s et al 40 confirmed a negative correlation between stiffness and necrosis and a positive correlation between stiffness and fibrosis. However, the present study showed a higher SR in Her-2-negative breast cancer than in Her-2-positive breast cancer, which is similar to the finding of You et al 38 This higher SR in Her-2 negative lesions might be associated with higher-degree fibrosis and lower-degree necrosis. Of the 248 Her-2-negative masses, 61% were in grade 2, probably explaining why their stiffness was greater than that in Her-2-positive masses.…”

“…The association between histological grade and sonoelastographic features remains controversial. Similar to those made by You et al and Lee et al, 38 , 39 this study showed that the SRs of grades 2 and 3 were greater than that of grade 1, but the SR of grade 3 was lower than that of grade 2. Chamming et al 40 suggested that necrosis, more in higher grades, was correlated with stiffness.…”

“…The relationship between PR status and lesion elasticity was controversial. 38,47 In this study, positive PR was associated with SR2, but not with SR1. Large sample and multi-center studies may be needed to determine the relationship between SR and these prognostic factors.…”

“…Overexpression of Her-2 is linked with cell proliferation, invasion, and metastasis, so Her-2-positive cells have more malignant phenotypes. 38 Her-2-positive tumors usually develop with more necroses and less pronounced desmoplastic reaction. 43 , 44 In a murine model, Chamming’s et al 40 confirmed a negative correlation between stiffness and necrosis and a positive correlation between stiffness and fibrosis.…”

Comparison between Histological Features and Strain Elastographic Characteristics in Canine Mammary Carcinomas

“…In our study, the elastogram characteristics were those expected, corroborating the malignancy of the tumors diagnosed by histology. These characteristics are similar to those described in women since they present a predominance of blue tones both in the visual color scale [22,[34][35][36][37] as well as observing a high strain ratio [24,[34][35][36]. In our work, we have not been able to make a comparison between benign and malignant mammary tumors because only one benign tumor was diagnosed compared to the 56 malignant neoplasms included in the study.…”