The mammographic appearance of breast carcinomas of invasive ductal type: Relationship with clinicopathological parameters, biological features and prognosis

Investigating the prognostic value of mammographic breast density and mammographic tumor appearance in women with invasive breast cancer: The Malmö Diet and cancer study

BACKGROUND

High breast density is a risk factor for breast cancer. However, whether density is a prognostic factor is debatable. Also, tumor appearances are related to tumor characteristics. Here we investigate the relationship between breast cancer-specific survival and mammographic breast density and mammographic tumor appearances.

METHODS

Women in the Malmö Diet and Cancer study with invasive breast cancer 1991-2014 were included (n = 1116). Mammographic information, patient and tumor characteristics, vital status, and causes of death were collected through 2018. Breast cancer-specific survival was assessed with Kaplan-Meier estimates and Cox proportional hazard models. Analyses were adjusted for established prognostic factors and stratified by detection mode.

RESULTS

High breast density did not significantly impact breast cancer-specific survival. However, there may be increased risk in women with dense breasts and screening-detected tumors (HR 1.45, CI 0.87-2.43). Neither did tumor appearance impact breast cancer-specific survival at long-term follow-up.

CONCLUSIONS

Breast cancer prognosis in women with high breast density on mammography does not seem impaired compared to women with less dense breasts, once the cancer is established. Neither does mammographic tumor appearance seem to inflict on prognosis, findings that can be of value in the management of breast cancer.

Mammographic tumour appearance is related to clinicopathological factors and surrogate molecular breast cancer subtype

Mammographic tumour appearance may provide prognostic useful information. For example, spiculation indicates invasiveness, but also better survival compared to tumours with other appearances. We aimed to study the relationship between mammographic tumour appearance and established clinicopathological factors, including surrogate molecular breast cancer subtypes, in the large Malmö Diet and Cancer Study. A total of 1116 women with invasive breast cancer, diagnosed between 1991 and 2014, were included. Mammographic tumour appearance in relation to status for oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2, histological grade, Ki67 and molecular subtype was analysed using various regression models. All models were adjusted for relevant confounders, including breast density, which can affect mammographic appearance. The results consistently showed that spiculated tumours are indicative of favourable characteristics, as they are more likely to be ER and PR positive, and more often exhibit lower histological grade and lower Ki67 expression. Furthermore, spiculated tumours tend to be of luminal A-like subtype, which is associated with a good prognosis. The establishment of associations between mammographic tumour appearance and clinico­pathological factors may aid in characterizing breast cancer at an earlier stage. This could contribute to more individualized breast cancer treatment in the future.

Radiomics Analysis on Ultrasound for Prediction of Biologic Behavior in Breast Invasive Ductal Carcinoma

INTRODUCTION

In current clinical practice, invasive ductal carcinoma is always screened using medical imaging techniques and diagnosed using immunohistochemistry. Recent studies have illustrated that radiomics approaches provide a comprehensive characterization of entire tumors and can reveal predictive or prognostic associations between the images and medical outcomes. To better reveal the underlying biology, an improved understanding between objective image features and biologic characteristics is urgently required.

PATIENTS AND METHODS

A total of 215 patients with definite histologic results were enrolled in our study. The tumors were automatically segmented using our phase-based active contour model. The high-throughput radiomics features were designed and extracted using a breast imaging reporting and data system and further selected using Student's t test, interfeature coefficients and a lasso regression model. The support vector machine classifier with threefold cross-validation was used to evaluate the relationship.

RESULTS

The radiomics approach demonstrated a strong correlation between receptor status and subtypes (P < .05; area under the curve, 0.760). The appearance of hormone receptor-positive cancer and human epidermal growth factor receptor 2-negative cancer on ultrasound scans differs from that of triple-negative cancer.

CONCLUSION

Our approach could assist clinicians with the accurate prediction of prognosis using ultrasound findings, allowing for early medical management and treatment.

Association between mammographic features and clinicopathological characteristics in invasive ductal carcinoma of breast cancer

The aim of the present study was to evaluate the association between mammographic features and clinicopathological characteristics in invasive ductal carcinoma. A total of 231 patients were retrospectively reviewed from January, 2011 to December, 2012. Statistical analysis was performed using Fisher's exact test, χ² test, Spearman's correlation and logistic regression, as appropriate. Of the 231 patients who underwent mammography, malignant calcifications were significantly more frequent in carcinomas that were human epidermal growth factor receptor 2 (HER2)-positive (P=0.001) or had a >2 cm size tumor (P=0.006). The pleomorphic-type was correlated with a p53-positive status (P=0.039) or lymph node metastasis (P=0.048), whereas the indistinct amorphous-type was associated with a HER2-positive status (P=0.026). An evident mass was frequently observed in higher Ki-67 expression-level tumors (P=0.002). In conclusion, the aforementioned correlations are noteworthy as they potentially reflect tumor attributes and may serve as a guide for treatment.

Imaging features of HER2 overexpression in breast cancer: a systematic review and meta-analysis

Breast cancer imaging phenotype is diverse and may relate to molecular alterations driving cancer behavior. We systematically reviewed and meta-analyzed relations between breast cancer imaging features and human epidermal growth factor receptor type 2 (HER2) overexpression as a marker of breast cancer aggressiveness. MEDLINE and EMBASE were searched for mammography, breast ultrasound, magnetic resonance imaging (MRI), and/or [(18)F]fluorodeoxyglucose positron emission tomography studies through February 2013. Of 68 imaging features that could be pooled (85 articles, 23,255 cancers; random-effects meta-analysis), 11 significantly related to HER2 overexpression. Results based on five or more studies and robustness in subgroup analyses were as follows: the presence of microcalcifications on mammography [pooled odds ratio (pOR), 3.14; 95% confidence interval (CI), 2.46-4.00] or ultrasound (mass-associated pOR, 2.95; 95% CI, 2.34-3.71), branching or fine linear microcalcifications (pOR, 2.11; 95% CI, 1.07-4.14) or extremely dense breasts on mammography (pOR, 1.37; 95% CI, 1.07-1.76), and washout (pOR, 1.57; 95% CI, 1.11-2.21) or fast initial kinetics (pOR, 2.60; 95% CI, 1.43-4.73) on MRI all increased the chance of HER2 overexpression. Maximum [(18)F]fluorodeoxyglucose standardized uptake value (SUVmax) was higher upon HER2 overexpression (pooled mean difference, +0.76; 95% CI, 0.10-1.42). These results show that several imaging features relate to HER2 overexpression, lending credibility to the hypothesis that imaging phenotype reflects cancer behavior. This implies prognostic relevance, which is especially relevant as imaging is readily available during diagnostic work-up.

The mammographic correlations with Basal-like phenotype of invasive breast cancer

RATIONALE AND OBJECTIVES

Mammography contributes to the improvement of breast carcinoma survival through early detection and treatment of breast lesions. The basal-like phenotype has been found to be an independent poor prognostic factor for breast cancer. The aim of this study was to determine the mammographic correlates of the basal-like phenotype of invasive breast cancer, and to more precisely predict patient outcome and those individuals who will be responsive to a specific therapeutic regimen.

MATERIALS AND METHODS

The mammographic findings in 267 patients with operable breast cancer were correlated with the basal-like subtype identified using immunohistochemical assessment of breast cancer cases, including estrogen receptor, progesterone receptor, HER-2/neu status, cytokeratin (CK5/6), and epidermal growth factor receptor.

RESULTS

Of the 267 invasive breast cancers, 40 (15%) were of the basal-like phenotype. Basal-phenotype tumors were significantly more likely to manifest as a mass (P = .002), most of which were indistinct margin (P =.035), at mammography, and architecture distortion at mammography (P = .002).

CONCLUSION

The mammographic appearances of basal-like tumors, more mass and architecture distortion, suggest more rapid carcinogenesis. Additional studies are warranted to further refine prognosis, and to optimize treatment in patients with basal-like breast cancer.