Skip to main content

Advertisement

Log in

Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ

  • Breast
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate whether mass stiffness measured by shear-wave elastography (SWE) can predict the histological upgrade of ductal carcinoma in situ (DCIS) confirmed through ultrasound (US)-guided core needle biopsy (CNB).

Methods

The institutional review board approved this study and informed consent was waived. A database search revealed 120 biopsy-confirmed DCIS in patients who underwent B-mode US and SWE prior to surgery. Clinicopathologic results, B-mode findings, size on US, and mean and maximum elasticity values on SWE were recorded. Associations between upgrade to invasive cancer and B-mode US findings, SWE information, and clinical variables were assessed using univariate, multivariate logistic regression, and multiple linear regression analysis.

Results

The overall upgrade rate was 41.7 % (50/120). Mean stiffness value (P = .014) and mass size (P = .001) were significantly correlated with histological upgrade. The optimal cut-off value of mean stiffness value, yielding the maximal sum of sensitivity and specificity, was 70.7 kPa showing sensitivity of 72 % and specificity of 65.7 % for detecting invasiveness. Qualitative elasticity colour scores were significantly correlated with the histological upgrade, mammographic density, and B-mode category (P < .04).

Conclusion

Mean stiffness values evaluated through SWE can be utilized as a preoperative predictor of histological upgrade to invasive cancer in DCIS confirmed at US-guided needle biopsy.

Key Points

Higher stiffness values were noted in invasive cancer than DCIS.

Qualitative SWE colour scores significantly correlated with the histological upgrade.

Qualitative SWE colour scores had excellent interobserver agreement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

DCIS:

Ductal carcinoma in situ

IDC:

Invasive ductal carcinoma

SWE:

Shear-wave elastography

CNB:

Core needle biopsy

References

  1. Donahue EJ (2014) Ultrasound-Guided Breast Biopsy Tissue Sampling: Technique and Breast Ultrasound Characteristics of Benign and Malignant LesionsBreast Cancer. Springer, p 133–148

  2. Kim J, Han W, Lee JW et al (2012) Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision. Breast 21:641–645

    Article  PubMed  Google Scholar 

  3. Houssami N, Ambrogetti D, Marinovich ML et al (2011) Accuracy of a preoperative model for predicting invasive breast cancer in women with ductal carcinoma-in-situ on vacuum-assisted core needle biopsy. Ann Surg Oncol 18:1364–1371

    Article  PubMed  Google Scholar 

  4. Kurniawan ED, Rose A, Mou A et al (2010) Risk factors for invasive breast cancer when core needle biopsy shows ductal carcinoma in situ. Arch Surg 145:1098–1104

    Article  PubMed  Google Scholar 

  5. Brennan ME, Turner RM, Ciatto S et al (2011) Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology 260:119–128

    Article  PubMed  Google Scholar 

  6. Chang W-C, Hsu H-H, Yu J-C et al (2014) Underestimation of invasive lesions in patients with ductal carcinoma in situ of the breast diagnosed by ultrasound-guided biopsy: a comparison between patients with and without HER2/neu overexpression. Eur J Radiol 83:935–941

    Article  PubMed  Google Scholar 

  7. Schulz S, Sinn P, Golatta M et al (2013) Prediction of underestimated invasiveness in patients with ductal carcinoma in situ of the breast on percutaneous biopsy as rationale for recommending concurrent sentinel lymph node biopsy. Breast 22:537–542

    Article  PubMed  Google Scholar 

  8. Park SH, Kim MJ, Kim SJ, Kim E-K (2014) Ductal carcinoma in situ diagnosed using an ultrasound-guided 14-gauge core needle biopsy of breast masses: can underestimation be predicted preoperatively? Ultrasonography 33:128

    Article  PubMed  PubMed Central  Google Scholar 

  9. Moran CJ, Kell MR, Flanagan FL, Kennedy M, Gorey TF, Kerin MJ (2007) Role of sentinel lymph node biopsy in high-risk ductal carcinoma in situ patients. Am J Surg 194:172–175

    Article  PubMed  Google Scholar 

  10. Hung WK, Ying M, Chan M, Mak KL, Chan LK (2010) The impact of sentinel lymph node biopsy in patients with a core biopsy diagnosis of ductal carcinoma in situ. Breast Cancer 17:276–280

    Article  PubMed  Google Scholar 

  11. Lyman GH, Temin S, Edge SB et al (2014) Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 32:1365–1383

    Article  PubMed  Google Scholar 

  12. Barr RG (2010) Real-time ultrasound elasticity of the breast: initial clinical results. Ultrasound Q 26:61–66

    Article  PubMed  Google Scholar 

  13. Barr RG, Destounis S, Lackey LB, Svensson WE, Balleyguier C, Smith C (2012) Evaluation of breast lesions using sonographic elasticity imaging a multicenter trial. J Ultrasound Med 31:281–287

    PubMed  Google Scholar 

  14. Athanasiou A, Tardivon A, Tanter M et al (2010) Breast lesions: quantitative elastography with supersonic shear imaging—preliminary results 1. Radiology 256:297–303

    Article  PubMed  Google Scholar 

  15. Berg WA, Cosgrove DO, Doré CJ et al (2012) Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology 262:435–449

    Article  PubMed  Google Scholar 

  16. Itoh A, Ueno E, Tohno E et al (2006) Breast Disease: Clinical Application of US Elastography for Diagnosis 1. Radiology 239:341–350

    Article  PubMed  Google Scholar 

  17. Destounis S, Arieno A, Morgan R et al (2013) Clinical experience with elasticity imaging in a community-based breast center. J Ultrasound Med 32:297–302

    PubMed  Google Scholar 

  18. Cosgrove DO, Berg WA, Dore CJ et al (2012) Shear wave elastography for breast masses is highly reproducible. Eur Radiol 22:1023–1032

    Article  PubMed  Google Scholar 

  19. Chang JM, Moon WK, Cho N et al (2011) Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat 129:89–97

    Article  PubMed  Google Scholar 

  20. Evans A, Whelehan P, Thomson K et al (2010) Quantitative shear wave ultrasound elastography: initial experience in solid breast masses. Breast Cancer Res 12:R104

    Article  PubMed  PubMed Central  Google Scholar 

  21. Evans A, Whelehan P, Thomson K et al (2012) Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology

  22. Zeichner SB, Herna S, Mani A et al (2015) Survival of patients with de-novo metastatic breast cancer: analysis of data from a large breast cancer-specific private practice, a university-based cancer center and review of the literature. Breast Cancer Res Treat 153:617–624

    Article  CAS  PubMed  Google Scholar 

  23. Choi WJ, Kim HH, Cha JH et al (2014) Predicting prognostic factors of breast cancer using shear wave elastography. Ultrasound Med Biol 40:269–274

    Article  PubMed  Google Scholar 

  24. Chen L, He J, Liu G et al (2014) Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis. Jpn J Radiol 32:592–599

    Article  CAS  PubMed  Google Scholar 

  25. Cho N, Moon WK, Chang JM et al (2011) Sonoelastographic lesion stiffness: preoperative predictor of the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy. Eur Radiol 21:1618–1627

    Article  PubMed  Google Scholar 

  26. Sickles E, D'Orsi CJ, Bassett LW et al (2013) ACR BI-RADS® MammographyACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. American College of Radiology, Reston

    Google Scholar 

  27. Chang JM, Park IA, Lee SH et al (2013) Stiffness of tumours measured by shear-wave elastography correlated with subtypes of breast cancer. Eur Radiol 23:2450–2458

    Article  PubMed  Google Scholar 

  28. Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410

    Article  CAS  PubMed  Google Scholar 

  29. Mendelson EB, Böhm-Vélez M, Berg WA et al (2013) ACR BI-RADS® Ultrasound.ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. American College of Radiology, Reston

    Google Scholar 

  30. Berg WA, Mendelson EB, Cosgrove DO et al (2015) Quantitative Maximum Shear-Wave Stiffness of Breast Masses as a Predictor of Histopathologic Severity. Am J Roentgenol 205:448–455

    Article  Google Scholar 

  31. Chamming’s F, Latorre-Ossa H, Le Frère-Belda M et al (2013) Shear wave elastography of tumour growth in a human breast cancer model with pathological correlation. Eur Radiol 23:2079–2086

    Article  PubMed  Google Scholar 

  32. Shoma A, Moutamed A, Ameen M, Abdelwahab A (2006) Ultrasound for accurate measurement of invasive breast cancer tumor size. Breast J 12:252–256

    Article  PubMed  Google Scholar 

  33. Hieken TJ, Harrison J, Herreros J, Velasco JM (2001) Correlating sonography, mammography, and pathology in the assessment of breast cancer size. Am J Surg 182:351–354

    Article  CAS  PubMed  Google Scholar 

  34. Lee JW, Han W, Ko E et al (2008) Sonographic lesion size of ductal carcinoma in situ as a preoperative predictor for the presence of an invasive focus. J Surg Oncol 98:15–20

    Article  PubMed  Google Scholar 

  35. Moon WK, Myung JS, Lee YJ, Park IA, Noh D-Y, Im J-G (2002) US of Ductal Carcinoma In Situ 1. Radiographics 22:269–281

    Article  PubMed  Google Scholar 

  36. Londero V, Zuiani C, Furlan A, Nori J, Bazzocchi M (2007) Role of ultrasound and sonographically guided core biopsy in the diagnostic evaluation of ductal carcinoma in situ (DCIS) of the breast. Radiol Med 112:863–876

    Article  CAS  PubMed  Google Scholar 

  37. Cho N, Moon WK, Park J-S (2009) Real-time US elastography in the differentiation of suspicious microcalcifications on mammography. Eur Radiol 19:1621–1628

    Article  PubMed  Google Scholar 

  38. Tunon-de-Lara C, Chauvet MP, Baranzelli MC et al (2015) The Role of Sentinel Lymph Node Biopsy and Factors Associated with Invasion in Extensive DCIS of the Breast Treated by Mastectomy: The Cinnamome Prospective Multicenter Study. Ann Surg Oncol :1–8

  39. Worni M, Akushevich I, Greenup R et al (2015) Trends in treatment patterns and outcomes for ductal carcinoma in situ. J Natl Cancer Inst 107:djv263

    Article  PubMed  Google Scholar 

  40. Yi A, Moon WK, Cho N et al (2013) Association of tumour stiffness on sonoelastography with axillary nodal status in T1 breast carcinoma patients. Eur Radiol 23:2979–2987

    Article  PubMed  Google Scholar 

  41. Lee SH, Cho N, Chang JM et al (2014) Two-view versus single-view shear-wave elastography: comparison of observer performance in differentiating benign from malignant breast masses. Radiology 270:344–353

    Article  PubMed  Google Scholar 

  42. Youk JH, Son EJ, Gweon HM, Kim H, Park YJ, Kim J-A (2014) Comparison of Strain and Shear Wave Elastography for the Differentiation of Benign From Malignant Breast Lesions, Combined With B-mode Ultrasonography: Qualitative and Quantitative Assessments. Ultrasound Med Biol 40:2336–2344

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Woo Kyung Moon. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jung Min Chang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bae, J.S., Chang, J.M., Lee, S.H. et al. Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ. Eur Radiol 27, 7–15 (2017). https://doi.org/10.1007/s00330-016-4359-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4359-6

Keywords

Navigation