Tumor growth rate of invasive breast cancers during wait times for surgery assessed by ultrasonography

Abstract

Several studies suggest that delay in the surgical treatment of breast cancer is significantly associated with lower survival. This study evaluated the tumor growth rate (TGR) of invasive breast cancers during wait times for surgery quantitatively using ultrasonography (US) and identified clinicopathologic factors associated with TGR.This retrospective study was approved by our institutional review board and the requirement for written informed consent was waived. Between August 2013 and September 2014, a total of 323 unifocal invasive breast cancers in 323 women with serial US images at the time of diagnosis and surgery were included. Tumor diameters and volumes were measured using 2-orthogonal US images. TGR during wait times for surgery was quantified as specific growth rates (SGR; %/day) and was compared with clinicopathologic variables using univariate and multivariate analyses.Median time from diagnosis to surgery was 31 days (range, 8–78 days). Maximum tumor diameters and volumes at the time of surgery (mean, 15.6 mm and 1.6 cm3) were significantly larger than at diagnosis (14.7 mm and 1.3 cm3) (P < 0.001). On multivariate analysis, surrogate molecular subtype was a significant independent factor of SGR (P = 0.001); triple negative cancers showed the highest SGR (1.003%/day) followed by HER2-positive (0.859 %/day) and luminal cancers (luminal B, 0.208 %/day; luminal A, 0.175%/day) (P < 0.001). Clinical T stage was more frequently upgraded in nonluminal (triple negative, 18% [12/67]; HER2-positive, 14% [3/22]) than luminal cancers (luminal B, 3% [1/30]; luminal A, 2% [4/204]) (P < 0.001).Invasive breast cancers with aggressive molecular subtypes showed faster TGR and more frequent upgrading of clinical T stage during wait times for surgery.

The Impact of Pre-Operative Breast MRI on Surgical Waiting Time

“…While delays in breast cancer treatment are associated with tumor growth, especially in triple negative molecular subtypes which can reach specific growth rates of up to 1.003% per day [20], the relationship between treatment delays and survival is more controversial. Given its significant effect on tumor growth, the presence of a triple negative molecular subtype may conceivably lead to doubts about the necessity of pre-operative MRI delays [20].…”

“…Given its significant effect on tumor growth, the presence of a triple negative molecular subtype may conceivably lead to doubts about the necessity of pre-operative MRI delays [20]. However, Love et al have shown that despite a larger tumor size and more frequent axillary node involvement, delays of less than 6 months had no statistically significant impact on survival [21].…”

A Mathematical Model to Predict Diagnostic Periods for Secondary Distant Metastases in Patients with ER/PR/HER2/Ki-67 Subtypes of Breast Cancer

“…The TVDT is one of the most critical parameters used to develop the consolidated mathematical growth model of the PT and sdMTSs of BC (CoMPaS) and to calculate the earliest diagnostic period of sdMTSs in patients with BC [ 21 ]. The TVDT, which helped in the development of the mathematical growth model, is a combined quality indicator that reflects the subtype of BC, the proliferative activity, the degree of tumor differentiation, the Nottingham prognostic index (NPI) score, receptor activity (ER(+), ER(−), PR(+), PR(−), HER2(+), HER2(−), Ki-67), and triple-negative BC [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 ]. Hence, patients can obtain a personalized approach for building a schedule of multimodal examinations to detect sdMTSs at the early stage and to start early treatment that can increase the patient’s life [ 43 ].…”

“…The growth rate of the PT in patients with BC is calculated via TVDT PT [ 36 , 37 , 38 , 39 , 44 , 45 , 46 , 47 ]. An ultrasound-based diagnosis allows a better detection of the changes in PT sizes in patients with BC to calculate TVDT PT [ 48 , 49 , 50 , 51 , 52 , 53 , 54 ].…”

Determining the thermal characteristics of breast cancer based on high-resolution infrared imaging, 3D breast scans, and magnetic resonance imaging

“…Potential clinical applications for the computational modeling of breast cancer include: Monitoring tumor response to cancer treatment over other imaging modalities; tracking tumor growth over time, including from presentation to surgical removal 53 ; and hyperthermia cancer treatment [49][50][51][52] .…”