Background: Breast cancer is the most common invasive cancer in women worldwide. Its prognosis depends upon tumor biology and molecular type. Mammography is globally accepted as the main modality for screening and early detection of breast cancer. Mammographically demonstrated morphological features can also provide clues about tumor subtypes. Our study aimed to evaluate the association between mammographic morphological features and molecular subtypes of breast cancer.
Results: This cross sectional study was conducted on 378 women with histo-pathologically confirmed breast cancer. Mammographic features of these women were assessed as per American College of Radiology- BIRADS lexicon and findings were recorded. Breast cancers were classified as Luminal A, Luminal B, HER2- enriched, or triple negative using ER, PR, HER2 receptor status and Ki-67 scores. Invasive ductal carcinoma was the most common type and accounted for 89.6% of the cases. Mammographic features differed significantly between molecular subtypes. Irregular masses and spiculated margins were more common in Luminal A and B subtypes whereas circumscribed round masses were more common in triple negative cancers (p < 0.001). HER2 enriched and triple negative cancers showed higher density masses (p <0.001). Pleomorphic microcalcifications were more common in Luminal A and HER2 enriched types (p <0.001). Logistic regression showed that round shape and circumscribed margins were associated with triple negative breast cancers. Microcalcifications and spiculated margins were associated with Luminal B and HER2 enriched cancers.
Conclusion: Mammographic features showed significant association with breast cancer subtypes. Hence mammography amy provide useful clues about tumor biology and help support individualized diagnosis and management.
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References
- https://www.who.int/news-room/fact-sheets/detail/breast-cance, "Breast cancer". World Health Organization. 12 March 2024. Retrieved 29 March 2024).
- World Health Organisation (2021): The global cancer observatory, source: Globocan 2020, 356-india-fact-sheets.pdf. Factsheet-India. World Health Organisation. https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf. Accessed 17 Jan 2023.
- Loibl S, Poortmans P, Morrow M, Denkert C, Curigliano G (May 2021). "Breast cancer". Lancet. 397 (10286):1750–1769. doi:10.1016/S0140-6736(20)32381-3. PMID 33812473. S2CID 232485291.
- Parker JS, Mullins M, Cheang MCU et al (2009) Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol 27:1160–1167
- Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ Panel members. Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22:1736–1747. doi: 10.1093/annonc/mdr304.
- Goldstein NS, Decker D, Severson D et al (2007) Molecular clas sification system identifies invasive breast carcinoma patients who are most likely and those who are least likely to achieve a complete pathologic response after neoadjuvant chemotherapy. Cancer 110:1687–1696
- Dent R, Trudeau M, Pritchard KI et al (2007) Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 13:4429–4434
- D’ Orsi CJ, Sickles EA, Mendelson EB, Morris EA (2013) ACR BI-RADS® Atlas, [11] breast imaging reporting and data system. 5th ed. Reston, VA: American College of Radiology; 2013.
- Orrantia-Borunda E, Anchondo-Nuñez P, Acuña-Aguilar LE, et al. Subtypes of Breast Cancer. In: Mayrovitz HN, editor. Breast Cancer [Internet]. Brisbane (AU): Exon Publications; 2022 Aug 6. Chapter 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK583808/# doi: 10.36255/exon-publications-breast-cancer-subtypes.
- Cho N. Imaging features of breast cancer molecular subtypes: state of the art. J Pathol Transl Med. 2021 Jan;55(1):16-25. doi: 10.4132/jptm.2020.09.03. Epub 2020 Nov 9. PMID: 33153242; PMCID: PMC7829574.
- Erber R, Hartmann A. Histology of Luminal Breast Cancer. Breast Care (Basel). 2020 Aug;15(4):327-336. doi: 10.1159/000509025. Epub 2020 Jul 15. PMID: 32982642; PMCID: PMC7490665.
- Lo Gullo R, Daimiel I, Morris EA, Pinker K. Combining molecular and imaging metrics in cancer: radiogenomics. Insights Imaging. 2020 Jan 3;11(1):1. doi: 10.1186/s13244-019-0795-6. PMID: 31901171; PMCID: PMC6942081.
- Adrada BE, Moseley TW, Kapoor MM, Scoggins ME, Patel MM, Perez F, Nia ES, Khazai L, Arribas E, Rauch GM, Guirguis MS. Triple-Negative Breast Cancer: Histopathologic Features, Genomics, and Treatment. Radiographics. 2023 Oct;43(10):e230034. doi: 10.1148/rg.230034. PMID: 37792593; PMCID: PMC10560981.
- Schopp JG, Polat DS, Arjmandi F, Hayes JC, Ahn RW, Sullivan K, Sahoo S, Porembka JH. Imaging Challenges in Diagnosing Triple-Negative Breast Cancer. Radiographics. 2023 Oct;43(10):e230027. doi: 10.1148/rg.230027. PMID: 37708071.
- Tamaki K, Ishida T, Miyashita M, Amari M, Ohuchi N, Tamaki N, Sasano H. Correlation between mammographic findings and corresponding histopathology: potential predictors for biological characteristics of breast diseases. Cancer Sci. 2011 Dec;102(12):2179-85. doi: 10.1111/j.1349-7006.2011.02088.x. Epub 2011 Oct 6. PMID: 21895869.
- Liu S, Wu XD, Xu WJ, Lin Q, Liu XJ, Li Y. Is There a Correlation between the Presence of a Spiculated Mass on Mammogram and Luminal A Subtype Breast Cancer? Korean J Radiol. 2016 Nov-Dec;17(6):846-852. doi: 10.3348/kjr.2016.17.6.846. Epub 2016 Oct 31. PMID: 27833400; PMCID: PMC5102912.
- Qi YJ, Su GH, You C, Zhang X, Xiao Y, Jiang YZ, Shao ZM. Radiomics in breast cancer: Current advances and future directions. Cell Rep Med. 2024 Sep 17;5(9):101719. doi: 10.1016/j.xcrm.2024.101719. PMID: 39293402; PMCID: PMC11528234.
- Rana N, Thakur S, Thakur V. et al. Mammographic parameters as predictors of molecular subtype of breast cancer: a prospective analysis. Surg Exp Pathol 7, 22 (2024). https://doi.org/10.1186/s42047-024-00169-x.
- Rayamajhi, K., Bansal, R., & Aggarwal, B. (2023). Mammographic correlation with molecular subtypes of breast carcinoma. Journal of Radiology and Oncology, 7(1), 001–005. https://doi.org/10.29328/journal.jro.1001045
- Boisserie-Lacroix M, Macgrogan G, Debled M, Ferron S, Asad-Syed M, McKelvie-Sebileau P, Mathoulin-Pélissier S, Brouste V, Hurtevent-Labrot G. Triple-negative breast cancers: associations between imaging and pathological findings for triple-negative tumors compared with hormone receptor-positive/human epidermal growth factor receptor-2-negative breast cancers. Oncologist. 2013;18(7):802-11. doi: 10.1634/theoncologist.2013-0380. Epub 2013 Jul 2. PMID: 23821326; PMCID: PMC3720633.
- Cen D, Xu L, Li N, Chen Z, Wang L, Zhou S, Xu B, Liu CL, Liu Z, Luo T. BI-RADS 3-5 microcalcifications can preoperatively predict breast cancer HER2 and Luminal a molecular subtype. Oncotarget. 2017 Feb 21;8(8):13855-13862. doi: 10.18632/oncotarget.14655. PMID: 28099938; PMCID: PMC5355144.

