Analysis The Characteristics Of Different Molecular Subtypes Of Breast Cancer By Digital Breast Tomosynthesis

Objective:To investigate the characteristics of different molecular subtypes of breast cancer in digital breast tomosynthesis(DBT)and the influential factors of spiculated mass,so as to provide objective imaging evidence for clinical decision making and prognosis evaluation.Methods:A total of 104 patients with breast cancer confirmed by surgery and pathology in our hospital from October 2016 to June 2018 were retrospectively analyzed.All patientsunderwentDBTbeforeoperation,andunderwentpostoperative immunohistochemical staining.The expression levels of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor-2(her-2)and ki-67 in tumor cells were assaied.They were divided into Luminal A,Luminal B,her-2+and triple-negative groups according to expression levels.To analyze the DBT features and clinicopathological features of each molecular subtype of breast cancer,and study the influential factors of spiculated mass.Results:Among the 104 cases of breast cancer,23 cases of Luminal A,44 cases of Luminal B,23 cases of her-2+and 14 cases of triple-negative.There were no statistically significant differences in age and lymph node metastasis among patients with different molecular subtypes of breast cancer(P>0.05).There were statistically significant differences in the distribution of pathological types(P<0.05).Among the45 patients with malignant calcification,23 cases showed single calcification.Her-2+breast cancer has the highest rate of malignant calcification,however,triple-negative is rarely associated with malignant calcification,the difference was statistically significant(?~2=12.899,P=0.005).There were 73 cases of mass tumor,and there was nostatisticallysignificantdifferenceamongthemolecularsubtypes(?~2=5.899,P=0.117).Mass boundary of Luminal and her-2+breast cancers are mainly unclear,but triple-negative breast cancer is mainly clear,the difference between molecular subtypes was statistically significant(?~2=18.845,P<0.001).Luminal breast cancer is mainly spiculated mass,triple-negative breast cancer is dominated by smooth edge,the difference between molecular subtypes was statistically significant(?~2=21.791,P<0.001).Comparison of the maximum diameter of the tumor revealed that the triple-negative breast cancer was larger than Luminal and her-2+breast cancer,the difference was no statistically significant(P=0.562).The proportion of high density mass of each molecular subtype was higher,the difference was no statistically significant(?~2=1.866,P=0.601).The study of influential factors of spiculated mass revealed that invasive ductal carcinoma(OR:6.341,95%CI:1.359-29.598,P=0.019),ER positive(OR:7.612,95%CI:2.073-27.951,P=0.002)and lower Ki-67(OR:4.153,95%CI:1.105-15.606,P=0.035)may be the significant factors in the presence of a spiculated mass.Conclusion:Her-2+breast cancer is often associated with malignant calcification,however,triple-negative breast cancer is rarely associated with malignant calcification.Each molecular subtype of breast cancer is mainly high density mass,Luminal breast cancer is characterized by unclear boundary and spiculated mass,the main manifestations of triple-negative breast cancer is the mass shadow with clear boundary,smooth edge and large diameter.Invasive ductal carcinoma,ER positive and lower Ki-67 may be the significant factors in the presence of a spiculated mass.DBT can clearly show the imaging signs of breast cancer,which has certain value in predicting the molecular subtype and prognosis of breast cancer,and provide imaging evidence for clinical individualized treatment.