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 (JR) 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 (JR 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 (JR 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 (JR 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.
Keywords
Breast cancer - mammography - microcalcifications - molecular subtype - posterior
acoustic features - predicting value - ultrasound - vascularity
