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Abstract
Purpose
To investigate the correlation of the strain elasticity of breast cancer with histologic features, immunohistochemical markers and molecular subtypes that are known to be factors related to prognosis.
Materials and Methods
B-mode ultrasound and strain elastography were performed in 123 patients (mean age, 53.4; range, 28–82) with invasive ductal carcinoma (IDC) (mean size, 1.54 cm; range, 0.4–7.0 cm). Histologic grade, lymph node (LN) status, lymphovascular invasion, immunohistochemical biomarkers [estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), CK5/6, epidermal growth factor receptor, and Ki-67] and molecular subtypes were determined from surgical pathology reports. The relationships between these factors and elasticity scores were evaluated.
Results
LN involvement was associated with a higher elasticity score which was statistically significant (p = 0.042). The tumor size, lymphovascular invasion, histologic grades, immunohistochemical markers and molecular subtypes had no significant correlation with the elasticity score (p > 0.05 for all). However, the IDCs with larger size and a positive lymphovascular invasion tended to have higher elasticity scores. Furthermore, higher histologic grade cancers and the HER2 overexpression-type tended to have lower elasticity scores.
References
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Fig. 1.
A 57-year-old woman diagnosed with an invasive ductal carcinoma (1 cm in size, T1/N1, histologic grade 2) in the left breast. A. B-mode ultrasound shows a hypoechoic mass with an irregular shape and a spiculated margin. B. Ultrasound elastography shows a mass with a higher elasticity score (score 4).
Fig. 2.
A 56-year-old woman diagnosed with an invasive ductal carcinoma (1.5 cm in size, T1/N0, histologic grade 3) in the right breast. A. B-mode ultrasound shows a hypoechoic mass with an irregular shape, an angular margin, and posterior shadowing. B. Ultrasound elastography shows a mass with a lower elasticity score (score 1).
Fig. 3.
A 41-year-old woman diagnosed with an invasive ductal carcinoma (2.8 cm in size, T2/N3, histologic grade 3) in the right breast. A. B-mode ultrasound shows a hypoechoic lesion with an irregular shape and angular margin. B. Ultrasound elastography shows a mass with a lower elasticity score (score 2).
Table 1.
Correlation of Pathologic Features and Presence of Hormone Receptors with the Elasticity Scores
| Elasticity Score | p-Value | |||||||
|---|---|---|---|---|---|---|---|---|
| Score 1 (n = 10) | Score 2 (n = 26) | Score 3 (n = 55) | Score 4 (n = 19) | Score 5 (n = 13) | Mean | 5-Score | 3-Subgroups∗ | |
| Size, cm | 0.226 | 0.664 | ||||||
| < 1 (n = 37) | 7 (18.9) | 6 (16.2) | 15 (40.5) | 5 (13.5) | 4 (10.8) | 2.81 | ||
| 1–2 (n = 53) | 3 (5.7) | 11 (20.0) | 27 (50.9) | 7 (13.2) | 5 (9.4) | 3.0 | ||
| ≥ 2 (n = 33) | 0 (0) | 9 (27.3) | 13 (39.4) | 7 (21.2) | 4 (12.1) | 3.18 | ||
| Histologic grade | 0.812 | 0.590 | ||||||
| Grade 1 (n = 29) | 3 (10.3) | 5 (17.2) | 12 (41.4) | 5 (17.2) | 4 (13.8) | 3.07 | ||
| Grade 2 (n = 69) | 6 (8.7) | 13 (18.8) | 31 (44.9) | 11 (15.9) | 8 (11.6) | 3.03 | ||
| Grade 3 (n = 23) | 1 (4.3) | 8 (34.8) | 11 (47.8) | 2 (8.7) | 1 (4.3) | 2.74 | ||
| Lymph node | 0.093 | 0.042 | ||||||
| Positive (n = 27) | 0 (0.0) | 5 (18.5) | 10 (37.0) | 7 (25.9) | 5 (18.5) | 3.44 | ||
| Negative (n = 96) | 10 (10.4) | 21 (21.9) | 45 (46.9) | 12 (12.5) | 8 (8.3) | 2.86 | ||
| Lymphovascular invasion | 0.387 | 0.816 | ||||||
| Positive (n = 31) | 3 (9.7) | 5 (16.1) | 14 (45.2) | 3 (9.7) | 6 (19.4) | 3.13 | ||
| Negative (n = 91) | 7 (7.7) | 21 (23.1) | 41 (45.1) | 15 (16.5) | 7 (7.7) | 2.93 | ||
| Estrogen receptor | 0.646 | 0.301 | ||||||
| Positive (n = 97) | 7 (7.2) | 19 (19.6) | 43 (44.3) | 17 (17.5) | 11 (11.3) | 3.06 | ||
| Negative (n = 26) | 3 (11.5) | 7 (26.9) | 12 (46.2) | 2 (7.7) | 2 (7.7) | 2.73 | ||
| Progesterone receptor | 0.733 | 0.820 | ||||||
| Positive (n = 86) | 8 (9.3) | 18 (20.9) | 39 (45.3) | 14 (16.3) | 7 (8.1) | 2.93 | ||
| Negative (n = 37) | 2 (5.4) | 8 (21.6) | 16 (43.2) | 5 (13.5) | 6 (16.2) | 3.14 | ||
| HER-2 | 0.436 | 0.704 | ||||||
| Positive (n = 33) | 1 (3.0) | 9 (27.3) | 16 (48.5) | 3 (9.1) | 4 (12.1) | 3.0 | ||
| Negative (n = 88) | 9 (10.2) | 17 (19.3) | 37 (42.0) | 16 (18.2) | 9 (10.2) | 2.99 | ||
| CK5/6 | 0.473 | 0.698 | ||||||
| Positive (n = 16) | 2 (12.5) | 4 (25.0) | 6 (37.5) | 1 (6.3) | 3 (18.8) | 2.94 | ||
| Negative (n = 105) | 8 (7.6) | 22 (21.0) | 49 (46.7) | 17 (16.2) | 9 (8.6) | 2.97 | ||
| EGFR | 0.191 | 0.889 | ||||||
| Positive (n = 18) | 4 (22.2) | 2 (11.1) | 8 (44.4) | 2 (11.1) | 2 (11.1) | 2.78 | ||
| Positive (n = 18) Negative (n = 96) | 4 (22.2) 5 (5.2) | 2 (11.1) 22 (22.9) | 8 (44.4) 44 (45.8) | 2 (11.1) 15 (15.6) | 2 (11.1) 10 (10.4) | 2.78 3.03 | ||
| Negative (n = 96) Ki-67 | 5 (5.2) | 22 (22.9) | 44 (45.8) | 15 (15.6) | 10 (10.4) | 3.03 | 0.458 | 0.306 |
| Positive (n = 56) | 4 (7.1) | 16 (28.6) | 24 (42.9) | 7 (12.5) | 5 (8.9) | 2.88 | ||
| Positive (n = 56) Negative (n = 67) | 4 (7.1) 6 (9.0) | 16 (28.6) 10 (14.9) | 24 (42.9) 31 (46.3) | 7 (12.5) 12 (17.9) | 5 (8.9) 8 (11.9) | 2.88 3.09 | ||
∗ p-value obtained by dividing the five elasticity scores into three groups [i.e., low (score 1 and 2), intermediate (score 3), and high elasticity (score 4 and 5)] and comparing the three groups with respect to the variables.
CK5/6 = cytokeratin 5/6, EGFR = epidermal growth factor receptor, HER2 = human epidermal growth factor receptor 2
Table 2.
Correlation of Breast Cancer Subtypes with the Elasticity Scores
| Elasticity Score | p-Value | |||||||
|---|---|---|---|---|---|---|---|---|
| Score 1 | Score 2 | Score 3 | Score 4 | Score 5 | Mean | 5-Score | 3-Subgroup∗ | |
| Luminal (n = 101) | 8 (7.9) | 19 (18.8) | 46 (45.5) | 17 (16.8) | 11 (10.9) | 3.04 | 0.351 | 0.156 |
| HER2 overexpression (n = 10) | 0 (0) | 4 (40.0) | 6 (60.0) | 0 (0.0) | 0 (0.0) | 2.60 | ||
| Triple negative (n = 12) | 2 (16.7) | 3 (25.0) | 3 (25.0) | 2 (16.7) | 2 (16.7) | 2.92 | ||
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