Relationship Between Clustered Ring Nonmass Enhancement of Breast MRI and Prognostic Molecular Biomarkers in Breast Cancer

BackgroundClustered ring enhancement (CRE) of breast MRI is a lexicon of nonmass enhancement (NME) representing tendency of breast cancer and molecular biomarkers are predictors of response to therapy. The purpose of this study was to retrospectively determine the relationship between CRE NME and prognostic molecular biomarkers in breast cancer.MethodsRetrospective analysis of 58 breast lesions in 56 female patients between July 2013 and December 2018 was performed in our institution. Cases with MRI reporting NME in the text were collected via searching the report database. The patterns of enhancement including CRE on breast MRI were reviewed by a radiologist blinded to pathology report. The pathological results and expression of molecular biomarkers were collected. Univariate analysis was applied to evaluate the association between MRI NME imaging features, pathological and IHC stain findings.Results58 Breast lesions were pathologically proven breast carcinoma, and 31 lesions with CRE and 27 lesions without CRE on breast MRI. The expression of estrogen receptor (ER) (P=0.017) and progesterone receptor (PR) (P=0.017) was significantly lower in lesions with CRE compared with those without CRE. The expression of Ki-67 (≥ 25%) was significantly higher in lesions with CRE(P=0.046). The lesions with CRE have a lower expression ratio of ER (50.71 ± 45.39% vs. 74.26 ± 33.59%, p= 0.028).ConclusionOur results indicated that lesions with CRE may possess different features from those without CRE in molecular expression. They tend to bear a more aggressive biological behavior.

Qualitative and quantitative strain and shear wave elastography paradigm in differentiation of breast lesions

Background Breast cancer is the most common life-threatening cancer in women worldwide. A high number of women are going through biopsy procedures for characterization of breast masses every day and yet 75% of the pathological results prove these masses to be benign. Ultrasound (US) elastography is a non-invasive technique that measures tissue stiffness. It is convenient for differentiating benign from malignant breast tumors. Our study aims to evaluate the role of qualitative ultrasound elastography scoring (ES), quantitative mass strain ratio (SR), and shear wave elasticity ratio (SWER) in differentiation between benign and malignant breast lesions. Results Among 51 female patients with 77 histopathologically proved breast lesions, 57 breast masses were malignant and 20 were benign. All patients were examined by B-mode ultrasound then strain and shear wave elastographic examinations using ultrasound machine (Logiq E9, GE Medical Systems) with 8.5–12 MHz high-frequency probes. Our study showed that ES best cut-off point > 3 with sensitivity, specificity, PPV, NPP, accuracy was 94.7%, 85%, 94.7%, 85%, 90.9%, respectively, and AUC = 0.926 at P < 0.001, mass SR the best cut-off point > 4.6 with sensitivity, specificity, PPV, NPP, accuracy was 96.5%, 80%, 93.2%, 88.9%, 92.2%, respectively, and AUC = 0.860 at P < 0.001, SWER the best cut-off value > 4.9 with sensitivity, specificity, PPV, NPP and accuracy was 91.2%, 80%, 92.9%, 76.2%, 93.5%, respectively, and AUC = 0.890 at P < 0.001. The mean mass strain ratio for malignant lesions is 10.1 ± 3.7 SD and for solid benign lesions 4.7 ± 4.3 SD (p value 0.001). The mean shear wave elasticity ratio for malignant lesions is 10.6 ± 5.4 SD and for benign (solid and cystic) lesions 3.6 ± 4.2 SD. Using ROC curve and Youden index, the difference in diagnostic performance between ES, SR and SWER was not significant in differentiation between benign and malignant breast lesions and also was non-significant difference when comparing them with conventional US alone. Conclusion ES, SR, and SWER have a high diagnostic performance in differentiating malignant from benign breast lesions with no statistically significant difference between them.