Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2023; 11(33): 7994-8002
Published online Nov 26, 2023. doi: 10.12998/wjcc.v11.i33.7994
Comparative analysis of conventional ultrasound and shear wave elastography features in primary breast diffuse large B-cell lymphoma
Xiao-Duan Zhang, Kai Zhang
Xiao-Duan Zhang, Department of Ultrasound, The Affiliated Hospital of Guizhou Medical University, Guiyang 550081, Guizhou Province, China
Kai Zhang, Department of Medical Oncology, Shijiazhuang People's Hospital, Shijiazhuang 050000, Hebei Province, China
Author contributions: Zhang XD proposed the concept of this study, contributed to data collection, and drafted the first draft; Zhang K contributed to the formal analysis, guides research, methodlogy, and visualization of this study; Zhang XD and Zheng K participated in the research, validated this study, jointly reviewed and edited the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Guizhou Medical University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai Zhang, MD, Attending Doctor, Department of Medical Oncology, Shijiazhuang People's Hospital, No. 1 Fangbei Road, Shijiazhuang 050000, Hebei Province, China. zkai202207@163.com
Received: September 25, 2023
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
Abstract
BACKGROUND

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.

AIM

To compare the conventional US and SWE features of PB-DLBCL and evaluate their diagnostic performance and prognostic value.

METHODS

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, orientation, echo, posterior acoustic features, calcification, and vascularity) and SWE features (mean elasticity value, standard deviation, minimum elasticity value, maximum elasticity value, and lesion-to-fat ratio) of the PB-DLBCL lesions. Using receiver operating characteristic curve analysis, we determined the optimal cutoff values and diagnostic performance of conventional US and SWE features. We also performed a survival analysis to assess the prognostic value of conventional US and SWE features.

RESULTS

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).

CONCLUSION

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.

Keywords: Primary breast diffuse large B-cell lymphoma; Conventional ultrasound; Shear wave elastography; Diagnosis; Prognosis; Tumor behavior

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.