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. 2018 Sep;171(2):383-389.
doi: 10.1007/s10549-018-4836-5. Epub 2018 Jun 1.

Pre-operative stromal stiffness measured by shear wave elastography is independently associated with breast cancer-specific survival

Andy Evans  1 , Yee Ting Sim  2 , Celine Pourreyron  3 , Alastair Thompson  4 , Lee Jordan  5 , Dawn Fleming  5 , Colin Purdie  5 , Jane Macaskill  6 , Sarah Vinnicombe  2 , Paul Pharoah  7
Affiliations

Pre-operative stromal stiffness measured by shear wave elastography is independently associated with breast cancer-specific survival

Andy Evans et al. Breast Cancer Res Treat. 2018 Sep.

Abstract

Introduction: With the increased use of neoadjuvant therapy for breast cancer, there is a need for pre-operative prediction of prognosis. We aimed to assess the prognostic value of tumour stiffness measured by ultrasound shear wave elastography (SWE).

Methods: A consecutive cohort of patients with invasive breast cancer underwent breast ultrasound (US) including SWE. The following were recorded prospectively: US diameter, stiffness at SWE, presentation source, core biopsy grade, oestrogen receptor (ER) status and pre-operative nodal status. Breast cancer-specific survival (BCSS) was analysed with regard to US size and stiffness, tumour grade on core biopsy, ER status, presentation mode and pre-operative nodal status. Analysis used Cox proportional hazards regression.

Results: Of the 520 patients, 42 breast cancer and 53 non-breast cancer deaths were recorded at mean follow-up of 5.4 years. Hazard ratios (HR) for tertiles of stiffness were 1, 4.8 and 8.1 (P = 0.0001). HR for 2 groups based on US size < or ≥ 20 mm were 1 and 5.1 (P < 0.0001). HR for each unit increase in tumour grade on core biopsy was 3.9 (P < 0.0001). The HR for ER positivity compared to ER negativity was 0.21 (P < 0.001). BCSS was also associated with presentation mode and pre-operative nodal status. In a multivariable model, stiffness, US size and ER status were independently associated with BCSS.

Conclusion: Multiple pre-operative factors including stromal stiffness at SWE have independent prognostic significance. A larger dataset with longer follow-up could be used in the future to construct a pre-operative prognostic model to guide treatment decisions.

Keywords: Breast cancer; Neoadjuvant chemotherapy; Prognosis; Shear wave elastography; Ultrasound.

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Conflict of interest statement

AE has in the past had a PhD student part funded by Supersonic Imagine. The students work was not part of this project.

Ethical approval

Institutional Review Board ethical approval was waived for this retrospective analysis of prospectively recorded data and all patients gave permission for evaluation of their images.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves for three equal size groups based on stiffness at shear wave elastography
Fig. 2
Fig. 2
Kaplan-Meier survival curves according to ultrasound size
Fig. 3
Fig. 3
Kaplan-Meier survival curves according to core biopsy estimated histological grade
See this image and copyright information in PMC

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