Is there a potential biomarker in distinguishing invasive breast carcinomas with elevated Ki-67 levels among 2D-SWE, SMI, and 18F-FDG PET-CT/MRI-derived parameters?: A single-center data.

Purpose: To investigate the strength of quantitative imaging and metabolic parameters in differentiating invasive breast carcinomas with elevated Ki-67 levels.
Materials and Methods: A total of 123 patients with 129 breast lesions confirmed as invasive breast carcinoma underwent shear wave elastography (SWE), superb microvascular imaging (SMI) and positron emission tomography (PET)/CT or MRI. Adler's grade (classifying the microvascularity into four types) and Vascular Index (VI) was obtained by SMI as microvascular parameters. In addition, the stiffness value (E _mean ) was evaluated in kilopascal by SWE. The average of consecutive measurements was recorded as mean VI and mean E _mean . PET scan parameters were obtained as SUV _max and SUL _peak . Lesions were divided into two groups according to the Ki-67 expression, low as ≤ 14 and high as >14.
Results: Adler's grading was the most correlated imaging parameter with high Ki-67 expression (p < 0.05), while VI and E _mean had poor correlation (p > 0.05). SUV _max and SUL _peak indicated a significant linear correlation with Ki-67 but a moderate correlation with the high levels of Ki-67 (p < 0,001). The sensitivity of VI, E _mean , SUV _max and SUL _peak was 64.6%, 66.7%, 65.7%, and 66.7% when the cut-off point was set to 5.25, 102.5, 6.59, and 2.63, respectively. SUV _max had the highest AUC value of 0.740, according to the ROC curve analysis.
Conclusions: Our results suggest that the quantitative parameters obtained by advanced imaging methods may be useful in predicting the high proliferation in invasive breast carcinomas. But none of them is eligible to be used as an independent biomarker in distinguishing aggressive behavior. Nevertheless, as a noninvasive method, visual assessment of microvascular morphology using SMI increases the prognostic efficiency in invasive breast carcinomas.
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