The Imaging Features And Molecular Subtypes Correlation Of Breast Cancer In Young Women (≤30 Years Old)

Objective: The purpose of this study was to explore the correlation among the characteristics of ultrasound(US),digital mammography(DM)and digital breast tomosynthesis(DBT)of breast cancer in young women(≤30 years of age)and immunohistochemical molecular subtypes.And,we compared young female patients with middle-aged female patients(45-55 years old).In order to rationally optimize the choice of treatment plan.Materials and Methods: A retrospective analysis of 146 young female patients with breast US,DM,and DBT performed in the hospital from January 2015 to August2020,and confirmed by surgery and pathology,were breast cancer patients ≤30 years old.The imaging features were evaluated and classified with reference to the 5th Edition Breast Imaging Report and Data System(BI-RADS).The shape,margin,and size of the masses and lesions were evaluated.The shape and distribution of the calcifications lesions were assessed.The DM also evaluated the breast density;ultrasound assessed posterior feature and vascularity.The molecular subtypes were defined according to the 2015 revised St.Gallen International Expert Consensus Recommendation.Immunohistochemical detection of ER,PR and HER2,Ki-67 levels.In the HER2 assessment,tumors with a score of 3+ were classified as HER2 positive,tumors with a score of 0 or 1+ were classified as negative.In tumors with a score of 2+,FISH analysis of gene amplification was used to confirm the status of HER2.Lesions were divided into four molecular subtypes: Luminal type A(ER +,PR≥ 20%,Ki-67 <20% and HER2-),Luminal type B(ER +,HER2-,Ki-67 ≥ 20%,PR-Or <20%;ER +,HER2 +,any Ki-67,any PR),HER2 overexpression type(ER-,PR-,HER2 +)and triple negative(TN)type(ER-,PR-And HER2-).Using χ2 test or Fisher’s exact test,assuming the test level α=0.05.The difference was statistically significant with p<0.05.Results:(1)In the young group,the lesions were mostly palpable mass(61.0%),clinical stage T2(54.8%),histological grade Ⅱ(56.3%),invasive ductal carcinoma(84.9%),and axillary lymph node metastasis(58.9%).(2)In the middle-aged group,most of the lesions were palpable masses(72.1%),clinical stage T2(53.5%),histology grade Ⅱ(58.6%),invasive ductal carcinoma(81.5%),and normal axillary lymph nodes(65.0%).(3)In the ultrasound examination,(1)in the young group,the most common manifestations were simple masses(52.1%),irregular shapes(71.2%),indistinct/angular margins(28.0%),shadowing posterior feature(31.1%),and low vascularity(50.7%);(2)in the middle-aged group,the most common manifestations were simple masses(72.1%),irregular shapes(87.4%),spiculated margins(36.4%),shadowing posterior feature(49.0%),low vascularity(61.6%).(4)In the young group,90.4% of the patients were dense breasts(ACR c–d),9.6% were non-dense breasts(ACR a–b);in the middle-aged group,80.5% of patients were dense breasts,19.5% of patients belonged to non-dense breast.(5)In the DBT examination,(1)in the young group,the most common manifestations were masses with calcifications(46.6%),irregular shapes(76.0%),high density(59.2%),spiculated margins(52.0%),fine pleomorphic or coarse heterogeneous calcification(47.4%),grouped distribution(64.0%);(2)in the middle-aged group,the most common manifestations were masses with calcifications(50.8%),irregular shapes(90.1%),high density(69.6%),and spiculated margins(58.7%),fine pleomorphic or coarse heterogeneous calcification(48.5%),grouped distribution(66.7%).(6)In the DM examination,(1)in the young group,the most common manifestations were masses with calcifications(42.5%),irregular shapes(79.0%),and indistinct margins(56.3%);(2)in the middle-aged group,the most common manifestations were masses with calcifications(45.1%),irregular shapes(89.1%),indistinct margins(52.6%).(7)(1)In the ultrasound examination,Luminal B type was mostly manifested as masses with calcifications and indistinct/angular margins in the young group,while in the middle-aged groups,it was mostly manifested as simple masses with spiculated margins(p<0.001).Among TN type,the middle-aged group mostly showed a simple mass(p=0.029),and the round/oval shape was common in the young group(p=0.001).The vascularity on ultrasound in the young group was more abundant than that in the middle-aged group(p=0.02).(2)In the DBT examination,among TN type,round/oval shapes were common in the young group(p=0.001).In HER2 overexpression type,compared with the middle-aged group,simple calcifications lesions were common in the young group(p=0.046);the young group had more fine linear or linear branching calcifications,while the middle-aged group had more fine pleomorphic or coarse heterogeneous calcifications(p=0.005).(3)Luminal A type and Luminal B type had a larger proportion of spiculated margins when they were masses than TN type and HER2 overexpression type.(4)The proportion of HER2 overexpression type manifested as simple calcification lesions were greater than that of other subtypes.Conclusion: There is a certain correlation between the imaging manifestations of breast cancer in young women and middle-aged women with different molecular subtypes,and has a certain predictive effect on its molecular subtypes,which can provide a certain degree for the clinical diagnosis and prognosis of breast cancer.