Evaluation Of The Association Between Mammographic Density And The Risk Of Breast Cancer And Breast Cancer Molecular Subtypes Using Quantra Software And BI-RADS In Women

Objective:We aimed to evaluate the relationship between MD and the risk of breast cancer in women in our district using BI-RADS classification and Quanra software,and to explore the relationships between MD and breast cancer molecular subtypes and tumor markers.Also we purposed to identify the corresponding high-risk population of breast cancer with higher gland density and provide corresponding guidance for the clinical prevention and treatment of breast cancer in the future.Methods:As for the case group,472 female breast cancer patients who were treated in the Galactophore Department of Shanxi Provincial People’s Hospital and underwent digital mammography during September 2017 to June 2018 were enrolled.All patients were pathologically diagnosed with breast cancer by surgery or biopsy.The control group selected from 1901 females who had a negative mammographic examination(BI-RADS1-2)during the same time.All participants received digital mammography(Standard positions of bilateral CC and MLO),and raw data were transmitted to the breast workstation and CDS for processing.All participants need to complete a questionnaire on risk factors of breast cancer and reproductive factors.Then we analyzed the consistency and correlation of two evaluation methods on MD,BI-RADS classification and Quantra software.A case-control study was used to evaluate the risk relationship between MD and the breast cancer using BI-RADS classification and Quanra software.After risk stratification for fertility factors,we further evaluated the associations between the risks of breast cancer,the breast Volume of Fibroglandular(VFG)and the breast Volumetric percentage of Breast Density(VBD).Finally,the relationships between MD and tumor markers and molecular subtypes of breast cancer were analyzed.Results:1.1 There was a perfect interobserver agreement(κ=0.843)between observer 1 and 2for assessment of BI-RADS density categories.A moderate consistence was observed between the consistency classification of BI-RADS density and Quantra category(κ=0.661).There was a significant positive correlation between BI-RADS classification and Quantra categories by spearman(r=0.789).1.2 There were significant differences between VFG,VB and VBD of different BI-RADS classifications by rank-sum test(all p<0.001).Besides,the VFG and VBD of breast increased with the increase of BI-RADS classification.1.3 With the increase of age,breast VFG and VBD showed a decreasing trend(p<0.05),and with the increase of BMI group,breast VBD showed a decreasing trend(p<0.05).2.1 Compared to females with BI-RADS category 2,the risk of breast cancer in females with BI-RADS category 3 increased by 0.37 times(p<0.05),and the risk of breast cancer in females with BI-RADS category 4 increased by 0.95 times(p<0.05).Additionally,compared to females identified as Quantra category 2,the risk of breast cancer in females identified as Quantra category 4 had a 0.76-fold increased risk of breast cancer(p< 0.05).2.2 Compared to females with category 2 of VBD,females with category 5 VBD had a 0.63 times increased risk of breast cancer(p<0.05).Compared to females with category 2VFG,women with category 4 and 5 VFG had a 0.62 and 0.92 fold increased risk of breast cancer,respectively(both p<0.05).2.3 After the risk stratification of fertility factors in the VBD and VFG classifications,there were significant differences between age at menarche,number of births,age at first childbirth and duration of breastfeeding groups(all p≤0.001).3.1 Using category 1 VFG as a reference,females with category 4 VFG had a0.57-fold increased risk of ER+ breast cancer(p<0.05),a 1.09-fold increased risk of ER-breast cancer(p<0.05),a 0.52-fold increased risk of PR+ breast cancer(p<0.05),and a1.15-fold increased risk of PR-breast cancer(p<0.05).The risk of HER2-negative breast cancer was also significantly increased by 0.60 times(p<0.05).3.2 After the quartile classification of breast VBD,there was no significant statistical difference between the Q1 classification and the other classifications.(all p> 0.05).3.3 Compared with category 1 VFG,females with category 4 VFG had a 0.95-fold increased risk of Luminal A breast cancer(p<0.05),and a 0.53-fold increased risk of Luminal B breast cancer(p<0.05).There were no significant differences between the HER2-positive enriched and TNBC types(both p>0.05).3.4 Using the first classification of VBD as reference,no significant statistical difference was found among all subtypes of breast cancer with other classifications of VBD(all p>0.05).Conclusion:1.Comparing the MD of health women in our district evaluated by Quantra software and BI-RADS density classification,we found that there was a moderate uniformity of the weighted kappa and significant positive correlation between the two methods.2.Both the BI-RADS classification and Quantra volume density software indicated that MD was positively associated with the risk of breast cancer in women in our district and that fertility-related factors had a certain regulatory effect on the risk relationship between MD and breast cancer.3.The higher VFG classification was positively correlated with the risks of ER±/PR±breast cancer,and the risks of ER-/PR-breast cancer was higher than ER+/PR+ breast cancer.Women with higher VFG classification have an increased risk of Luminal A and Luminal B breast cancer.