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. 2022 Mar;29(2):296-301.
doi: 10.1007/s12282-021-01311-3. Epub 2021 Nov 15.

The value of prognostic ultrasound features of breast cancer in different molecular subtypes with a focus on triple negative disease

Andy Evans  1 , Yee Ting Sim  2 , Brooke Lawson  2 , Jane Macaskill  2 , Lee Jordan  2 , Alastair Thompson  3
Affiliations

The value of prognostic ultrasound features of breast cancer in different molecular subtypes with a focus on triple negative disease

Andy Evans et al. Breast Cancer. 2022 Mar.

Abstract

The ultrasound (US) features of breast cancer have recently been shown to have prognostic significance. We aim to assess these features according to molecular subtype. 1140 consecutive US visible invasive breast cancers had US size and mean stiffness by shearwave elastography (SWE) recorded prospectively. Skin thickening (> 2.5 mm) overlying the cancer on US and the presence of posterior echo enhancement were assessed retrospectively while blinded to outcomes. Cancers were classified as luminal, triple negative (TN) or HER2 + ve based on immunohistochemistry and florescent in-situ hybridization. The relationship between US parameters and breast cancer specific survival (BCSS) was ascertained using Kaplan-Meier survival curves and ROC analysis. At median follow-up 6.3 year, there were 117 breast cancer (10%) and 132 non-breast deaths (12%). US size was significantly associated with BCSS all groups (area under the curve (AUC) 0.74 in luminal cancers, 0.64 for TN and 0.65 for HER2 + ve cancers). US skin thickening was associated most strongly with poor prognosis in TN cancers (53% vs. 80% 6 year survival, p = 0.0004). Posterior echo enhancement was associated with a poor BCSS in TN cancers (63% vs. 82% 6 year survival, p = 0.02). Mean stiffness at SWE was prognostic in the luminal and HER2 positive groups (AUC 0.69 and 0.63, respectively). In the subgroup of patients with TN cancers receiving neo-adjuvant chemotherapy posterior enhancement and skin thickening were not associated with response. US skin thickening is a poor prognostic indicator is all 3 subtypes studied, while posterior enhancement was associated with poor outcome in TN cancers.

Keywords: Breast cancer; Molecular subtype; Prognosis; Shear wave elastography; Ultrasound.

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Conflict of interest statement

Author Alastair Thompson declares no conflict of interest. Author Lee Jordan declares no conflict of interest. Author Jane Macaskill declares no conflict of interest. Author Brooke Lawson declares no conflict of interest. Author Yee Ting Sim declares no conflict of interest. Author Andy Evans declares no conflict of interest.

Figures

Fig. 1
Fig. 1
Ultrasound image of a triple negative breast cancer showing thickening of the overlying skin as indicated by the callipers
Fig. 2
Fig. 2
Ultrasound image of a triple negative breast cancer showing posterior echo enhancement as shown by the arrow heads
Fig. 3
Fig. 3
Kaplan–Meier survival curves (in years) for triple negative breast cancers according to the presence of skin thickening
Fig. 4
Fig. 4
Kaplan–Meier survival curves (in years) for triple negative breast cancers according to the presence of posterior echo enhancement
See this image and copyright information in PMC

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