Breast Imaging, Ninewells Hospital and Medical School, Mailbox 4, Level 6, Dundee, DD1 9SY, UK.
Jackie Wood Cancer Centre, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
Breast Cancer Res Treat. 2018 Sep;171(2):383-389. doi: 10.1007/s10549-018-4836-5. Epub 2018 Jun 1.
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).
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.
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.
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.
随着乳腺癌新辅助治疗的应用增加，术前预测预后的需求也随之增加。我们旨在评估超声剪切波弹性成像（SWE）测量的肿瘤硬度的预后价值。
连续入组的浸润性乳腺癌患者接受了乳腺超声（US）检查，包括 SWE。前瞻性记录以下内容：US 直径、SWE 硬度、首发部位、核心活检分级、雌激素受体（ER）状态和术前淋巴结状态。分析 US 大小和硬度、核心活检肿瘤分级、ER 状态、首发模式和术前淋巴结状态与乳腺癌特异性生存（BCSS）的关系。采用 Cox 比例风险回归分析。
在 520 例患者中，平均随访 5.4 年后记录了 42 例乳腺癌和 53 例非乳腺癌死亡。硬度三分位的危险比（HR）分别为 1、4.8 和 8.1（P<0.0001）。根据 US 大小<20mm 和≥20mm 分组的 HR 分别为 1 和 5.1（P<0.0001）。核心活检肿瘤分级每增加 1 级的 HR 为 3.9（P<0.0001）。与 ER 阴性相比，ER 阳性的 HR 为 0.21（P<0.001）。BCSS 还与首发模式和术前淋巴结状态相关。在多变量模型中，硬度、US 大小和 ER 状态与 BCSS 独立相关。
包括 SWE 间质硬度在内的多个术前因素具有独立的预后意义。未来可以使用更大的数据集和更长的随访时间构建术前预后模型，以指导治疗决策。
