The effectiveness of sono-mammographic findings in predicting the molecular subtypes of breast cancer. Using a sono-mammography score in distinguishing between non-triple-negative and triple-negative breast cancer

Abstract

Abstract Background Breast cancer is the most frequently diagnosed invasive cancer among women. Knowing the molecular subtyping of breast cancer is a standard approach for personalized cancer treatment, helping to evaluate the prognosis of the disease and prevent unnecessary treatment. Assessing the molecular subtypes of breast cancer via imaging can be intricate, as it requires the combination of imaging features from both ultrasound and mammography. The study aimed to assess the effectiveness of mammographic and ultrasound imaging features in predicting breast cancer’s molecular status. It also utilized a scoring system implemented by Shaikh and Rasheed to analyze the imaging characteristics of non-triple-negative versus triple-negative breast cancers. Methods We initiated this prospective research study from December 2022 to June 2024, involving 248 patients diagnosed with breast masses. Each patient underwent both digital mammography and ultrasound examinations. We assessed the mammographic and sonographic features of the breast carcinomas using the analytical criteria of the breast imaging reporting and data system (BI-RADS). Subsequently, we conducted a histopathological evaluation to determine the tumor type, grade, and molecular subtypes. We also followed a scoring system previously implemented by Shaikh and Rasheed to comprehend the imaging characteristics of non-triple-negative breast cancer (non-TNBC) in comparison with triple-negative breast cancers (TNBCs). Results Invasive ductal carcinoma was the most common pathological type detected in 201 lesions (81%) while grade II was the most encountered among the studied cases found in 135 lesions (54.4%) and Luminal B was the most common molecular subtype presented in 119 cases (48%). Sono-mammographic imaging features showed a statistically significant difference regarding lesions’ shape, margin, number, skin thickening, nipple retraction, and axillary lymphadenopathy between the different molecular subtypes (p < 0.001). Breast lesions with round or oval shapes, well-circumscribed or microlobulated margins, non-calcified or microcalcifications, posterior enhancement, parallel orientation, grade III tumors, and positive KI + 67 are significant predictors of triple-negative breast cancer, with odds ratios of 1.23, 5.76, 2.14, 200.03, 1.106, 2.706, and 1.25, respectively. Conclusions The current study showed that sono-mammographic findings can serve as valuable tools for identifying molecular subtypes of breast cancer. Different molecular subtypes exhibit unique imaging characteristics, particularly triple-negative breast cancer, which tends to display the least aggressive features.

Keywords

• Molecular subtypes
• Breast cancer
• Luminal A
• Luminal B
• HER2 expression/amplification
• Mammography