Mammographic Patterns Reflecting Molecular Subtypes in Breast Cancer: A Cross-Sectional Study

Abstract

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.