Do mammographic tumor features in breast cancer relate to breast density and invasiveness, tumor size, and axillary lymph node involvement?

Abstract

Background Breast density and mammographic tumor features of breast cancer may carry prognostic information. The potential benefit of using the combined information obtained from breast density, mammographic tumor features, and pathological tumor characteristics has not been extensively studied. Purpose To investigate how mammographic tumor features relate to breast density and pathological tumor characteristics. Material and Methods This retrospective study was carried out within the Malmö Diet and Cancer Study: a population-based cohort study recruiting 17,035 women during 1991–1996. A total of 826 incident breast cancers were identified during follow-up. Mammography images were collected and analyzed according to breast density and tumor features at diagnosis. Pathological data were retrieved from medical reports. Mammographic tumor features in relation to invasiveness, tumor size, and axillary lymph node involvement were analyzed using logistic regression yielding odds ratios (OR) with 95% confidence intervals (CI) and adjusted for age at diagnosis, mode of detection, and breast density. Results Tumors presenting as an ill-defined mass or calcifications were more common in dense breasts than tumors presenting as a distinct mass or with spiculated appearance. Invasive cancer was more common in tumors with spiculated appearance than tumors presenting as a distinct mass (adjusted OR, 5.68 [1.81–17.84]). Among invasive tumors, an ill-defined mass was more often large (>20 mm) compared with a distinct mass, (adjusted OR, 3.16 [1.80–5.55]). Conclusion Tumors presenting as an ill-defined mass or calcifications were more common in dense breasts. Spiculated appearance was related to invasiveness, and ill-defined mass to larger tumor size, regardless of mode of detection and breast density. The potential role of mammographic tumor features in clinical decision-making warrants further investigation.

Mammographic and clinical characteristics of different phenotypes of screen-detected and interval breast cancers in a nationwide screening program

“…Early detection and characterization are essential to ensure optimal treatment. On mammography, the best technique for screening, certain findings (e.g., certain types of calcifications, spiculated masses, or architectural distortion) suggest malignancy and can even be considered markers of poor prognosis [1,2]. However, findings among tumors vary, and few findings are specific for malignant or premalignant lesions.…”

“A Proteogenomic workflow reveals distinct molecular phenotypes related to breast cancer appearance”

“…ESR1 mutations (Toy et al, 2013)), or other prognostic factors such as appearance (e.g. spiculated appearances (Sartor et al, 2015)) have yet to be thoroughly investigated.…”

“…Mammographic techniques and improved image analysis have revealed that a breast cancer can exhibit different mammographic appearances, such as spiculations. Mammographic spiculated tumors possess a star-like appearance, which is an indicator of invasiveness linked to cancer infiltration and fibrotic growth around the tumor (Sartor et al, 2015;Alexander et al, 2006). On the molecular level, spiculated tumors have been shown to be enriched in ER and PgR positive tumor group, often comprised within the Luminal A molecular subtype, and have been linked to better prognosis when compared to well-defined and microcalcified masses (Evans et al, 2006;Taneja et al, 2008;Bullier et al, 2013).…”

The association of single nucleotide polymorphisms (SNPs) with breast density and breast cancer survival: the Malmö Diet and Cancer Study

“…Breast density was graded (fat involuted/moderately dense/dense) in the original radiology report of the breast cancer diagnostic mammogram and retrospectively retrieved for research purposes ( 6 , 25 – 27 ). The classification can be regarded as a modified Breast Imaging Reporting and Data System (BI-RADS) 4th Ed density categorization.…”