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

Published version
Peer-reviewed

Type

Article

Change log

Authors

Evans, Andy 
Sim, Yee Ting 
Pourreyron, Celine 
Thompson, Alastair 
Jordan, Lee 

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.

Description

Keywords

Breast cancer, Neoadjuvant chemotherapy, Prognosis, Shear wave elastography, Ultrasound, Adult, Aged, Aged, 80 and over, Biomarkers, Breast Neoplasms, Elasticity, Elasticity Imaging Techniques, Female, Humans, Kaplan-Meier Estimate, Middle Aged, Neoplasm Grading, Neoplasm Staging, Preoperative Period, Prognosis, Tumor Microenvironment

Journal Title

Breast Cancer Res Treat

Conference Name

Journal ISSN

0167-6806
1573-7217

Volume Title

171

Publisher

Springer Science and Business Media LLC
Sponsorship
Cancer Research Uk (None)
Cancer Research Uk (None)