Relationship Between Mammographic And Clinicopathological Findings And Pathological Molecular Subtypes Of Ductal Carcinoma In Situ

Objective: To explore the relationship between mammographic and clinicopathological features and pathological molecular subtypes of ductal carcinoma in situ(DCIS),and provide more evidence for clinical personalized treatment and prognosis.Methods: To analyse the imaging data of 681 cases ductal carcinoma in situ confirmed by surgical pathology in Affiliated Hospital of Qingdao University from Jan 2016 to Dec2020 retrospectively.According to the immunohistochemical results,the tumors were classified as estrogen receptor(ER)positive type(297 lesions),human epidermal growth factor receptor 2(HER2)positive type(358 lesions)and triple negative type(26 lesions).All patients underwent X?ray mammography and ultrasonography before operation.According to the standard of the Breast Imaging Report and Data System(BI?RADS),the imaging manifestations of lesions with different molecular types were analyzed.The differences in clinicopathological features and imaging manifestations among pathological molecular subtypes of DCIS were analyzed by using the Pearson chi-square test or Fisher exact test for categorical variables and the Analysis of Variance or rank sum test for continuous variables.Results: All patients were females(range 27 to 87 years),the most common age is 40-49 years old(36.0%),followed by 50-59 years old(32.3%).The population in our study is mixed,with only a small number of screening population(288/681,42.3%).Among those patients with clinical presentations,the most common presentation was palpable mass which accounted for about 40.0%(272/681).(1)Clinicopathological characteristics: high nuclear grade,comedo type,high Ki67 were more frequently observed in HER2 positive type and triple negative type than in ER positive type(all P<0.017).What’s more,the DCIS lesions of HER2 positive type was larger than that of the ER positive lesions(2.5cm vs1.6cm),and the difference was statistically significant.Moreover,the lesions with calcification on mammography were more associated with high nuclear grade,comedo type,high Ki67,negative ER,positive HER2 and high Ki67 than those non?calcified lesions.(2)For mammography,totally 20.5% lesions in ER positive type were negative,40.5% lesions in HER2 positive type showed calcification with mass,asymmetric density and structural distortion(P<0.017).The fine pleomorphic(108/263,41.1%),fine linear and fine linear branching calcifications(51/263,19.4%)were more common in HER2 positive type,while amorphous calcifications(92/173,53.2%)were more easier to detect in ER positive type.Besides,clustered distributed calcification(78/173,45.1%)was more common in ER positive type,and the linear,segment distribution(106/263,40.3%)were more common in HER2 positive type,and the difference was statistically significant(P<0.017).(3)For ultrasound,the most common ultrasound manifestations of all subtypes DCIS were mass(382/681,56.1%)and hypo-echoic areas(152/681,22.3%),and abnormalities of the ducts were 63 cases(9.3%).In contrast,point-like hyperechoic areas(21/681,3.1%)and structural distortion(13/681,1.9%)were relatively rare.There was little difference in the lesion types on ultrasound imaging between the different molecular subtypes of DCIS.Besides,most masses lesions in HER2 positive type and triple negative type had an irregular shape,indistinct margins,posterior shadowing,and often accompanied by pointlike hyperechoic areas(all P <0.017).Conclusion: The clinicopathological characteristics and imaging features of DCIS are related to different molecular subtypes.HER2 positive type,triple negative type and calcification lesions on mammography showed higher malignancy in clinicopathological features and more aggressive biological behavior.Some imaging features on mammography and ultrasound can provide valuable information for predicting the expression of molecular biomarkers in DCIS lesions.