Correlating Tumor Stiffness with Immunohistochemical Subtypes of Breast Cancers: Prognostic Value of Comb-Push Ultrasound Shear Elastography for Differentiating Luminal Subtypes.

Max Denis,Sejal Shah,Azra Alizad,Karthik Ghosh,Mahdi Bayat,Robert T Fazzio,Dana H Whaley,Mostafa Fatemi,Adriana Gregory,Aamir Ahmad

doi:10.1371/journal.pone.0165003

Max Denis, Sejal Shah + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0165003

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Journal: PloS one	Publication Date: Oct 24, 2016
Citations: 38	License type: CC BY 4.0

Affiliation: Mayo Clinic

Abstract

PurposeThe purpose of our study is to correlate quantitatively measured tumor stiffness with immunohistochemical (IHC) subtypes of breast cancer. Additionally, the influence of prognostic histologic features (cancer grade, size, lymph node status, and histological type and grade) to the tumor elasticity and IHC profile relationship will be investigated.MethodsUnder an institutional review board (IRB) approved protocol, B-mode ultrasound (US) and comb-push ultrasound shear elastography (CUSE) were performed on 157 female patients with suspicious breast lesions. Out of 157 patients 83 breast cancer patients confirmed by pathology were included in this study. The association between CUSE mean stiffness values and the aforementioned prognostic features of the breast cancer tumors were investigated.ResultsOur results demonstrate that the most statistically significant difference (p = 0.0074) with mean elasticity is tumor size. When considering large tumors (size ≥ 8mm), thus minimizing the statistical significance of tumor size, a significant difference (p< 0.05) with mean elasticity is obtained between luminal A of histological grade I and luminal B (Ki-67 > 20%) subtypes.ConclusionTumor size is an independent factor influencing mean elasticity. The Ki-67 proliferation index and histological grade were dependent factors influencing mean elasticity for the differentiation between luminal subtypes. Future studies on a larger group of patients may broaden the clinical significance of these findings.

Highlights

Breast cancer is heterogeneous nature with several subtypes leads to differences in clinical treatment, outcomes and prognosis [1,2]
Our results demonstrate that the most statistically significant difference (p = 0.0074) with mean elasticity is tumor size
When considering large tumors, minimizing the statistical significance of tumor size, a significant difference (p< 0.05) with mean elasticity is obtained between luminal A of histological grade I and luminal B (Ki-67 > 20%) subtypes

Summary

Introduction

Breast cancer is heterogeneous nature with several subtypes leads to differences in clinical treatment, outcomes and prognosis [1,2]. To establish an effective treatment and to predict the clinical course and outcome of breast cancer, it is important to use the most reliable prognostic factors. These prognostic factors include immunohistochemical (IHC) profiles (estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status and Ki-67 proliferation index) [3,4,5,6], lymph node involvement and histological grade [7] and tumor size [8]. A higher Ki-67 index has been found to correlate with poorer prognosis and early recurrence. Ki-67 proliferation index must be considered in the treatment and follow-up of breast cancer patients [15]

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