Predicting the molecular subtype of breast cancer based on mammography and ultrasound findings

Abstract

Aim:To determine the correlation between mammography and ultrasound features of breast cancer with molecular subtypes and to calculate the predictive value of these features.Materials and Method:This is a prospective study of consecutive patients with breast cancer presenting between January 2016 and July 2017, who underwent mammography and/or ultrasound of breast and excision of the breast mass. Patients with contralateral breast mass, metastases, h/o prior cancer treatment, and other malignancies were excluded. On mammography, the presence or absence of microcalcification was noted. On ultrasound examination size, margins, microcalcification, posterior acoustic features, vascularity, and axillary nodes were assessed. Margins were categorized into circumscribed and non-circumscribed. Posterior acoustic features were classified into four categories: shadowing, enhancement, mixed, and no changes. Vascularity was assessed based on Adler's index into grades 0, 1, 2, and 3. Grades 0 and 1 were considered low and 2 and 3 were high.Results:Tumors with non-circumscribed margins and posterior acoustic shadowing were likely to be luminal A or B subtype of breast cancer [odds ratio (OR) 5.78; 95% confidence interval (CI) 3.68–9.80; P < 0.0001]. Tumors with non-circumscribed margins, posterior acoustic shadowing, and high vascularity were more likely to be luminal B subtype (OR 2.88; 95% CI 2–4.14; P- <0.0001). Tumors with microcalcification and posterior mixed acoustic pattern were strongly associated to be HER2-positive (OR 5.48; 95% CI 3.06–9.80; P < 0.0001). Tumors with circumscribed margins and posterior acoustic enhancement were highly suggestive of triple-negative breast cancer (OR 7.06; 95% CI 4.64–10.73; P < 0.0001).Conclusion:Microcalcification detected on mammography and certain ultrasound features such as circumscribed or non-circumscribed margins, posterior acoustic features, and vascularity are strongly correlated in predicting the molecular subtypes of breast cancer, and thus may further expand the role of conventional breast imaging.

Relationship between Calcification on Mammography and Human Epidermal Growth Factor Receptor 2 (HER-2) Expression in Breast Carcinoma

“…12 In a prospective study has found that triple negative as the most subtypes (23%) followed by HER-2 negative luminal B (21%). 10 Interestingly, positive calcifications have been shown in 15% of subjects with negative HER-2 similar to other research (10%). 10 Calcification in subjects with negative HER-2 is thought to be related to factors other than HER-2 such as hormonal factors.…”

“…10 Interestingly, positive calcifications have been shown in 15% of subjects with negative HER-2 similar to other research (10%). 10 Calcification in subjects with negative HER-2 is thought to be related to factors other than HER-2 such as hormonal factors. Another study has found a relationship between hormonal receptors which are positive estrogen receptor and calcification on mammography.…”

“…Amplification of HER-2 is considered as an independent poor prognostic factor in invasive breast carcinomas and has been associated with altered clinical responsiveness to systemic breast cancer treatment such as chemotherapy and antiestrogens. [7][8][9][10] The aim of the study was to determine the relationship between calcification on mammography and HER-2 expression in breast carcinoma.…”

Current Landscape of Breast Cancer Imaging and Potential Quantitative Imaging Markers of Response in ER-Positive Breast Cancers Treated with Neoadjuvant Therapy

“…US imaging features such as the absence of posterior acoustic shadowing and spiculation were significant predictors of pCR in HER2+ tumors [38]. On the other hand, no feature was found to associate with response in the TN subtype, and the presence of posterior shadowing was associated with HR+/HER2− breast cancers [60]. However, axillary lymph node characterization, which is most accurately managed by ultrasound [36], is largely independent of subtype.…”

A Prospective Trial Comparing the Accuracy Between Ultrasound Guided Fnac of Axillary Lymph Nodes and Sentinel Lymph Node Biopsy Using Methylene Blue Followed by Imprint Cytology in Clinically Node Negative Early Breast Cancers

“…Various morphological charecteristics 6 are available to identify node involvement apart from the size and enlargement alone. There are narrowing of node hilum with cortical thickening.…”