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Background  Shear wave elastography (SWE) is an ultrasound technique for the noninvasive quantification of tissue stiffness. The hypoxic tumor microenvironment promotes tumor stiffness and is associated with poor prognosis in cancer. We aimed to investigate the correlation between tumor hypoxia and histologic biomarkers and tumor stiffness measured by SWE in breast cancer.    Methods  From June 2016 to January 2018, 82 women with invasive breast cancer who underwent SWE before treatment were enrolled. Average tumor elasticity (E average ) and tumor-to-fat elasticity ratio (E ratio ) were extracted from SWE. Immunohistochemical staining of glucose transporter 1 (GLUT1) was used to assess tumor hypoxia in breast cancer tissues and automated digital image analysis was performed to assess GLUT1 activities. Spearman correlation and logistic regression analyses were performed to identify associations between GLUT1 expression and SWE values, histologic biomarkers, and molecular subtypes. The Mann–Whitney  U  test,  t  test, or Kruskal–Wallis test was used to compare SWE values and histologic features according to the GLUT1 expression (≤the median vs > median).    Results  E average  ( r  = 0.676) and E ratio  ( r  = 0.411) correlated significantly with GLUT1 expression (both  p  <  0.001). E average  was significantly higher in cancers with estrogen receptor (ER)–, progesterone receptor (PR)–, Ki67+, and high-grade ( p  <  0.05). E ratio  was higher in cancers with Ki67+, lymph node metastasis, and high-grade ( p  <  0.05). Cancers with high GLUT1 expression (>median) had higher E average  (mean, 85.4 kPa vs 125.5 kPa) and E ratio  (mean, 11.7 vs 17.9), and more frequent ER– (21.7% vs 78.3%), PR– (26.4% vs 73.1%), Ki67+ (31.7%% vs 68.3%), human epidermal growth factor receptor 2 (HER2) + (25.0% vs 75.0%), high-grade (28.6% vs 71.4%), and HER2-overexpressing (25.0% vs 75.0%) and triple-negative (23.1% vs 76.9%) subtypes ( p  <  0.05). Multivariable analysis showed that E average  was independently associated with GLUT1 expression ( p  <  0.001).    Conclusions  Tumor stiffness on SWE is significantly correlated with tumor hypoxia as well as histologic biomarkers. In particular, E average  on SWE has independent prognostic significance for tumor hypoxia in the multivariable analysis and can potentially be used as a noninvasive imaging biomarker to predict prognosis and pretreatment risk stratification in breast cancer patients.

Tumor stiffness measured by shear wave elastography correlates with tumor hypoxia as well as histologic biomarkers in breast cancer