Published online Nov 26, 2023. doi: 10.12998/wjcc.v11.i33.7994
Peer-review started: September 25, 2023
First decision: October 17, 2023
Revised: October 18, 2023
Accepted: November 13, 2023
Article in press: November 13, 2023
Published online: November 26, 2023
Processing time: 60 Days and 2 Hours
Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is a rare subtype of non-Hodgkin lymphoma that accounts for < 3% of extranodal lymphomas and 1% of breast tumors. Its diagnosis and management are challenging because of its rarity, heterogeneity, and aggressive behavior. Conventional ultrasound (US) is the first-line imaging modality for breast lesions; however, it has limited specificity and accuracy for PB-DLBCL. Shear wave elastography (SWE) is a novel US technique that measures tissue stiffness and may reflect the histological characteristics and biological behavior of breast lesions.
To compare the conventional US and SWE features of PB-DLBCL and evaluate their diagnostic performance and prognostic value.
We retrospectively reviewed the clinical data and US images of 32 patients with pathologically confirmed PB-DLBCL who underwent conventional US and SWE before treatment. We analyzed conventional US features (shape, margin, ori
The results showed that the PB-DLBCL lesions were mostly irregular in shape (84.4%), microlobulated or spiculated in margins (75%), parallel in orientation (65.6%), hypoechoic in echo (87.5%), and had posterior acoustic enhancement (65.6%). Calcification was rare (6.3%) and vascularity was variable (31.3% avascular, 37.5% hypovascular, and 31.3% hypervascular). The mean elasticity value of PB-DLBCL lesions was significantly higher than that of benign breast lesions (113.4 ± 46.9 kPa vs 27.8 ± 16.4 kPa, P < 0.001). The optimal cutoff value of the mean elasticity for distinguishing PB-DLBCL from benign breast lesions was 54.5 kPa, with a sensitivity of 93.8%, specificity of 92.9%, positive predictive value of 93.8%, negative predictive value of 92.9%, and accuracy of 93.3%. The mean elasticity value was also significantly correlated with Ki-67 expression level (r = 0.612, P < 0.001), which is a marker of tumor proliferation and aggressiveness. Survival analysis showed that patients with higher mean elasticity values (> 54.5 kPa) had worse overall survival (OS) and progression-free survival (PFS) than those with lower mean elasticity values (< 54.5 kPa) (P = 0.038 for OS and P = 0.027 for PFS).
Conventional US and SWE provide useful information for diagnosing and forecasting PB-DLBCL. SWE excels in distinguishing PB-DLBCL from benign breast lesions, reflects tumor proliferation and aggressiveness, and improves disease management.
Core Tip: Conventional ultrasound (US) and shear wave elastography (SWE) are valuable tools for diagnosing and prognosticating primary breast diffuse large B-cell lymphoma (PB-DLBCL). PB-DLBCL exhibits specific features on US, and SWE demonstrates higher elasticity values compared to benign breast lesions. The mean elasticity value correlates with tumor proliferation marker Ki-67 expression and predicts worse overall and progression-free survival. Utilizing both US and SWE improves the accuracy of diagnosis and provides valuable prognostic information for managing PB-DLBCL.