Yonsei Med J.  2016 May;57(3):599-605. 10.3349/ymj.2016.57.3.599.

Lymphangiogenesis in Breast Cancer Correlates with Matrix Stiffness on Shear-Wave Elastography

• Cha YJ
• Youk JH
• Kim BG
• Jung WH
• Cho NH

• KMID: 2374077
• DOI: http://doi.org/10.3349/ymj.2016.57.3.599

Abstract

PURPOSE
To correlate tumor stiffness and lymphangiogenesis in breast cancer and to find its clinical implications.
MATERIALS AND METHODS
A total of 140 breast cancer patients were evaluated. Tumor stiffness was quantitatively measured by shear-wave elastography in preoperative ultrasound examination, calculated as mean elasticity value (kPa). Slides of resected breast cancer specimens were reviewed for most fibrotic area associated with tumor. D2-40 immunohistochemical staining was applied for fibrotic areas to detect the lymphatic spaces. Microlymphatic density, tumor stiffness, and clinicopathologic data were analyzed.
RESULTS
Higher elasticity value was associated with invasive size of tumor, microlymphatic density, histologic grade 3, absence of extensive intraductal component, presence of axillary lymph node metastasis, and Ki-67 labeling index (LI) in univariate regression analysis, and associated with Ki-67 LI and axillary lymph node metastasis in multivariate regression analysis. Microlymphatic density was associated histologic grade 3, mean elasticity value, and Ki-67 LI in univariate regression analysis. In multivariate regression analysis, microlymphatic density was correlated with mean elasticity value.
CONCLUSION
In breast cancer, tumor stiffness correlates with lymphangiogenesis and poor prognostic factors.

Keyword

Breast neoplasms; lymphangiogenesis; fibrosis; elasticity imaging techniques

MeSH Terms

Adult
Aged
Aged, 80 and over
Breast/pathology
Breast Neoplasms/*diagnostic imaging/*pathology
Elasticity Imaging Techniques/*methods
Female
Humans
Lymph Nodes/pathology
Lymphangiogenesis/*physiology
Lymphatic Metastasis/*pathology
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Neoplasm Staging
Regression Analysis

Figure

• 

  Fig. 1 Lymphangiogenesis in fibrous stroma in tumor with high elasticity value and low elasticity value. In tumor with high elasticity value (case 19, mean elasticity value: 230.0 kPa) shows lymphatic spaces (maximal microlymphatic density: 23.0) embedded in fibrotic tumor stroma (A), which are highlighted by D2-40 immunohistochemical staining (B). In tumor with low elasticity value (case 116, mean elasticity value: 56.5 kPa), lymphatic space is rarely found in fibrotic area (C) by D2-40 staining (D) (arrowheads).

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