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©The Author(s) 2021.
World J Clin Oncol. Sep 24, 2021; 12(9): 808-822
Published online Sep 24, 2021. doi: 10.5306/wjco.v12.i9.808
Published online Sep 24, 2021. doi: 10.5306/wjco.v12.i9.808
Table 1 Classification of imaging features based on American College of Radiology Breast Imaging Reporting and Data System Lexicon
Imaging feature | Classification |
Mammogram | |
Appearance | Mass |
Asymmetry | |
High risk microcalcifications1 | |
Architectural distortion | |
Ultrasound | |
Margins | Spiculated |
Microlobulated | |
Circumscribed | |
Posterior acoustic features | Shadowing |
Enhancement | |
Mixed | |
None | |
Size | Maximum dimension on ultrasound (in mm) |
Echogenicity | Homogenous |
Heterogeneous | |
Complex cystic | |
Adler’s index | Low (Grade I) |
Medium (Grade II) | |
High (Grade III) |
Table 2 Distribution of demographic and imaging parameters based on molecular subtype
Total (n = 328) | DCIS (n = 53) | Luminal A (n = 139) | Luminal B (n = 38) | Her2 enriched (n = 50) | Triple negative (n = 48) | |
Mean age | 61.1 ± 11.75 | 59.1 ± 11.67 | 61.8 ± 11.80 | 60.2 ± 12.23 | 62.0 ± 9.63 | 61.3 ± 12.60 |
Presentation | ||||||
Clinic | 237 (72%) | 29 (55%) | 98 (71%) | 28 (74%) | 36 (72%) | 46 (96%) |
Screening | 91 (28%) | 24 (45%) | 41 (29%) | 10 (26%) | 14 (28%) | 2 (4%) |
Mass | 200 (61%) | 14 (26%) | 91 (65%) | 29 (76%) | 29 (58%) | 37 (77%) |
Architectural distortion | 17 (6%) | 7 (13%) | 10 (7%) | 0 (0%) | 0 (0%) | 0 (0%) |
Asymmetry | 40 (12%) | 6 (11%) | 16 (12%) | 3 (8%) | 9 (18%) | 6 (13%) |
High-risk microcalcifications | 105 (32%) | 27 (51%) | 33 (24%) | 12 (32%) | 24 (48%) | 9 (19%) |
Tumor size (on USG) | ||||||
< 20 | 136 (41%) | 22 (42%) | 71 (51%) | 20 (53%) | 19 (38%) | 4 (8%) |
≥ 20 | 154 (47%) | 9 (17%) | 55 (40%) | 17 (45%) | 29 (58%) | 44 (92%) |
Margins (on USG) | ||||||
Spiculated | 100 (30%) | 5 (9%) | 63 (45%) | 12 (32%) | 8 (16%) | 8 (17%) |
Microlobulated | 174 (60%) | 23 (43%) | 59 (42%) | 25 (66%) | 40 (80%) | 29 (60%) |
Circumscribed | 16 (5%) | 3 (6%) | 4 (3%) | 0 (0%) | 0 (0%) | 11 (23%) |
Echogenicity (on USG) | ||||||
Heterogeneous | 144 (44%) | 13 (25%) | 58 (42%) | 19 (50%) | 28 (56%) | 26 (54%) |
Homogenous | 146 (45%) | 18 (34%) | 68 (49%) | 18 (47%) | 20 (40%) | 22 (46%) |
Posterior acoustic features | ||||||
Shadow | 74 (23%) | 5 (9%) | 49 (35%) | 10 (26%) | 4 (8%) | 6 (13%) |
Enhancement | 85 (26%) | 5 (9%) | 23 (17%) | 8 (21%) | 6 (32%) | 33 (69%) |
Mixed | 36 (11%) | 5 (9%) | 15 (11%) | 3 (8%) | 9 (18%) | 4 (8%) |
None | 95 (29%) | 16 (30%) | 39 (28%) | 16 (42%) | 19 (38%) | 5 (10%) |
Adler’s vascularity | ||||||
High (Grade II & III) | 81 (25%) | 7 (13%) | 22 (16%) | 11 (29%) | 21 (42%) | 20 (42%) |
Low (Grade I) | 209 (64%) | 24 (45%) | 104 (75%) | 26 (68%) | 27 (54%) | 28 (58%) |
Axillary nodes | ||||||
Present | 56 (17%) | 0 (0%) | 25 (18%) | 1 (3%) | 14 (28%) | 16 (33%) |
Absent | 234 (71%) | 53 (100%) | 101 (73%) | 36 (95%) | 34 (68%) | 32 (67%) |
Not visible on US | 38 (14%) | 22 (42%) | 13 (9%) | 1 (3%) | 2 (1%) | 0 (0%) |
Table 3 Binomial univariate and multivariate logistic regressions (ER/PR positive vs negative)
ER/PR positive vs negative | Univariate | Multivariate (AUC = 0.792) | |||||
P | OR | CI | P | OR | CI | ||
Posterior acoustic features1 | Enhancement | d | 0.46 | (0.193 1.050) | d | 0.45 | (0.174 1.143) |
Shadowing | b | 4.26 | (1.617 11.633) | Not significant | |||
Margins2 | Spiculated | a | 4.16 | (2.268 7.975) | a | 0.41 | (1.085 4.606) |
Circumscribed | a | 0.15 | (0.023 0.594) | Not significant | |||
Size | Small < 20 mm | c | 4.51 | (2.499 7.443) | a | 2.74 | (1.475 5.204) |
Table 4 Binomial univariate and multivariate logistic regressions (Triple-negative breast cancer vs Non-triple-negative breast cancer)
TNBC vs Non-TNBC | Univariate | Multivariate (AUC = 0.853) | |||||
P | OR | CI | P | OR | CI | ||
Posterior acoustic features1 | Enhancement | b | 5.08 | (1.808 18.201) | a | 4.77 | (1.556 18.291) |
Margins2 | Spiculated | a | 0.43 | (0.179 0.951) | Not significant | ||
Circumscribed | c | 11.00 | (3.712 37.166) | b | 8.24 | (2.151 38.923) | |
Size | Large > 20 mm | c | 13.2 | (5.152 44.845) | c | 10.5 | (3.792 38.436) |
Axillary node metastasis | Yes | b | 2.52 | (1.247 4.988) | Not significant | ||
Adler’s Index | High | a | 2.12 | (1.104 4.020) | Not significant | ||
aScreening | Yes | d | 0.003 | (0.000 0.222) | d | 0.004 | (0.000 0.452) |
aInteraction term | Screen × unit size | d | 1.17 | (1.003 1.505) | d | 1.16 | (1.001 1.430) |
Table 5 Binomial univariate and multivariate logistic regressions (HER2+ vs Non HER2+)
Table 6 Binomial univariate and multivariate logistic regressions (Ductal carcinoma in situ vs Invasive cancers)
DCIS vs Invasive cancers | Univariate | Multivariate (AUC = 0.719) | |||||
P | OR | CI | P | OR | CI | ||
Posterior acoustic features1 | None | a | 3.24 | (1.204 10.292) | a | 3.45 | (1.255 11.118) |
High-risk microcalcifications | Present | b | 2.80 | (1.516 5.208) | Not significant | ||
Architectural distortions | Yes | b | 5.34 | (1.546 16.709) | Not significant | ||
Size | Small < 20 mm | a | 2.59 | (1.420 7.361) | a | 2.72 | (1.172 6.182) |
Table 7 Multinomial univariate logistic regressions: Impact of imaging features on relative odds of molecular subtypes
Luminal A baseline | Luminal B baseline | DCIS baseline | HER2 enriched baseline | TNBC baseline | |||||||||||||
P value | OR | 95%CI | P value | OR | 95%CI | P value | OR | 95%CI | P value | OR | 95%CI | P value | OR | 95%CI | |||
Posterior acoustic features | Shadowing | Luminal A vs | d | 3.27 | (0.832 12.83) | b | 7.35 | (1.979 27.300) | |||||||||
Luminal B vs | a | 7.50 | (1.307 43.030) | ||||||||||||||
DCIS vs | d | 0.31 | (0.078 1.202) | ||||||||||||||
HER2+ vs | b | 0.14 | (0.037 0.505) | a | 0.13 | (0.023 0.765) | |||||||||||
TNBC vs | |||||||||||||||||
Enhancement | Luminal A vs | b | 0.19 | (0.055 0.633) | |||||||||||||
Luminal B vs | |||||||||||||||||
DCIS vs | a | 0.12 | (0.024 0.610) | ||||||||||||||
HER2+ vs | a | 0.22 | (0.058 0.807) | ||||||||||||||
TNBC vs | b | 5.38 | (1.581 18.310) | a | 8.25 | (1.638 41.55) | a | 4.64 | (1.239 17.38) | ||||||||
Margins (on US) | Spiculated | Luminal A vs | a | 2.45 | (1.130 5.31) | b | 5.41 | (1.931 15.14) | c | 5.88 | (2.544 13.58) | c | 4.26 | (1.805 10.056) | |||
Luminal B vs | a | 0.41 | (0.188 0.885) | d | 2.40 | (0.861 6.690) | |||||||||||
DCIS vs | b | 0.19 | (0.066 0.518) | ||||||||||||||
HER2+ vs | c | 0.17 | (0.074 0.393) | d | 0.42 | (0.150 1.16) | |||||||||||
TNBC vs | c | 0.24 | (0.099 0.554) | ||||||||||||||
Circumscribed | Luminal A vs | b | 0.09 | (0.019 0.445) | |||||||||||||
Luminal B vs | |||||||||||||||||
DCIS vs | |||||||||||||||||
HER2+ vs | |||||||||||||||||
TNBC vs | b | 10.8 | (2.246 52.043) | ||||||||||||||
Size | Large | Luminal A vs | a | 0.51 | (0.258 0.999) | c | 0.07 | (0.024 0.208) | |||||||||
Luminal B vs | c | 0.08 | (0.023 0.259) | ||||||||||||||
DCIS vs | c | 0.04 | (0.010 0.134) | ||||||||||||||
HER2+ vs | a | 1.97 | (1.001 3.878) | c | 0.14 | (0.043 0.450) | |||||||||||
TNBC vs | c | 14.20 | (4.811 41.915) | c | 12.94 | (3.856 43.427) | c | 26.89 | (7.445 97.114) | c | 7.21 | (2.224 23.354) | |||||
High-risk Microcals | Present | Luminal A vs | c | 0.30 | (0.154 0.583) | b | 0.34 | (0.171 0.665) | |||||||||
Luminal B vs | d | 0.44 | (0.186 1.061) | ||||||||||||||
DCIS vs | c | 3.34 | (1.715 6.488) | d | 2.25 | (0.942 5.37) | b | 4.50 | (1.606 9.96) | ||||||||
HER2+ vs | b | 2.97 | (1.504 5.844) | b | 4.00 | (1.824 11.10) | |||||||||||
TNBC vs | b | 0.22 | (0.090 0.548) | 0.25 | (0.100 0.623) | ||||||||||||
Adler | High | Luminal A vs | c | 0.27 | (0.131 0.566) | b | 0.30 | (0.142 0.618) | |||||||||
Luminal B vs | |||||||||||||||||
DCIS vs | d | 0.38 | (0.136 1.037) | d | 0.41 | (0.147 1.131) | |||||||||||
HER2+ vs | c | 3.68 | (1.767 7.650) | d | 2.67 | (0.965 7.37) | |||||||||||
TNBC vs | b | 3.38 | (1.618 7.045) | d | 2.45 | (0.884 6.78) | |||||||||||
Axillary node adenopathy | Yes | Luminal A vs | a | 3.08 | (1.063 61.96) | a | 0.44 | (0.209 0.919) | |||||||||
Luminal B vs | a | 0.12 | (0.224 0.470) | a | 0.07 | (0.009 0.556) | b | 0.05 | (0.007 0.430) | ||||||||
DCIS vs | |||||||||||||||||
HER2+ vs | a | 14.40 | (1.798 115.17) | ||||||||||||||
TNBC vs | a | 2.28 | (1.088 4.778) | b | 18.50 | (2.323 147.34) |
- Citation: Ian TWM, Tan EY, Chotai N. Role of mammogram and ultrasound imaging in predicting breast cancer subtypes in screening and symptomatic patients. World J Clin Oncol 2021; 12(9): 808-822
- URL: https://www.wjgnet.com/2218-4333/full/v12/i9/808.htm
- DOI: https://dx.doi.org/10.5306/wjco.v12.i9.808