title: Clinical application of a color map pattern on shear-wave elastography for invasive breast cancer.
abstract: OBJECTIVE
  The aim of this study was to classify the color map pattern on shear-wave elastography (SWE) and to determine its association with clinicopathological factors for clinical application in invasive breast cancer.
  
  
  METHODS
  From June to December 2014, 103 invasive breast cancers were imaged by B-mode ultrasonography (US) and SWE just before surgery. The color map pattern identified on the SWE could be classified into three main categories: type 1 (diffuse pattern), increased stiffness in the surrounding stroma and the interior lesion itself; type 2 (lateral pattern), marked peri-tumoral stiffness at the anterior and lateral portions with no or minor stiffness at the posterior portion; and type 3 (rim-off pattern), marked peri-tumoral stiffness at the anterior and posterior portion with no or minor stiffness at both lateral portions.
  
  
  RESULTS
  High-grade density on mammography (grade 3-4) was more frequent in the type 1 pattern than the other pattern types (80.5% in high-grade density vs. 19.5% in low-grade density). For type 1 tumors, the extent of synchronous non-invasive cancers (pT0), ductal carcinoma in situ (DCIS), was 1.8-2.0 times wider than that measured by US or magnetic resonance imaging (MRI). For type 2 tumors, the invasive tumor components (pT size) size was 1.3 times greater than measured by MRI (p = 0.049). On the other hand, the pT size and pT0 extent of type 3 tumors were almost equal to the preoperative US and MRI measurements. In terms of immunohistochemical (IHC) profiles, type 3 tumors showed a high histologic grade (p = 0.021), poor differentiation (p = 0.009), presence of necrosis (p = 0.018), and high Ki-67 (p = 0.002). The percentage of HER2-positive cancers was relatively high within the type 2 group, and the percentage of triple negative breast cancer was relatively high in the type 3 group (p = 0.011).
  
  
  CONCLUSIONS
  We expect that assessments of the SWE color map pattern will prove useful for surgical or therapeutic plan decisions and to predict prognosis in invasive breast cancer patients.
authors.affiliation: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Seokwon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Younglae
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. Electronic address: bytae@pusan.ac.kr.
authors.forename: Youngtae
authors.initials: Y
authors.lastname: Bae
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003116:Color; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010364:Pattern Recognition, Visual; D011379:Prognosis; D016217:Ultrasonography, Mammary / Q000379:methods; D055815:Young Adult
keywords: Color map pattern; Invasive breast cancer; Shear wave elastography