Purpose
Increased levels of stromal tumor-infiltrating lymphocytes (sTILs) have recently been
considered a favorable independent prognostic and predictive biomarker in triple-negative
breast cancer (TNBC). The purpose of this study was to determine the relationship
between BI-RADS (Breast Imaging Reporting and Data System) ultrasound lexicon descriptors
and sTILs in TNBC.
Materials and Methods
Patients with stage I-III TNBC were evaluated within a single-institution neoadjuvant
clinical trial. Two fellowship-trained breast radiologists used the BI-RADS ultrasound
lexicon to assess pretreatment tumor shape, margin, echo pattern, orientation, posterior
features, and vascularity. sTILs were defined as low <20 or high ≥20 on the pretreatment
biopsy. Fisher's exact tests were used to assess the association between lexicon descriptors
and sTIL levels.
Results
The 284 patients (mean age 52 years, range 24-79 years) were comprised of 68% (193/284)
with low-sTIL tumors and 32% (91/284) with high-sTIL tumors. TNBC tumors with high
sTILs were more likely to have the following features: (1) oval/round shape than irregular
shape (p = 0.003), (2) circumscribed or microlobulated margins than spiculated, indistinct,
or angular margins (p = 0.0005); (3) complex cystic and solid pattern than heterogeneous pattern (p = 0.006); and (4) posterior enhancement than shadowing (p = 0.002). There was no significant association between sTILs and descriptors for orientation
and vascularity (p = 0.06 and p = 0.49, respectively).
Conclusion
BI-RADS ultrasound descriptors of the pretreatment appearance of a TNBC tumor can
be useful in discriminating between tumors with low and high sTIL levels. Therefore,
there is a potential use of ultrasound tumor characteristics to complement sTILs when
used as stratification factors in treatment algorithms for TNBC.
Key Words
- Triple-negative breast cancer
- stromal tumor infiltrating lymphocytes (sTILs)
- breast ultrasound
- BI-RADS. Abbreviations: ACR, American College of Radiology
- BI-RADS, Breast Imaging Reporting and Data System
- ER, estrogen receptor
- HER2, human epidermal growth factor receptor 2
- pCR, pathologic complete response
- PR, progesterone receptor
- sTIL, stromal tumor-infiltrating lymphocyte
- TNBC, triple-negative breast cancer
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Article info
Publication history
Published online: July 13, 2021
Accepted:
June 9,
2021
Received in revised form:
June 9,
2021
Received:
May 3,
2021
Identification
Copyright
© 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
