Ultrasound and Mammographic Findings as Predictors of Biological Markers in Breast Cancer: Retrospective Analysis.

Document Type : Original Article

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The Department of Diagnostic & Interventional Radiology* and Pathology Department**, Faculty of Medicine, Alexandria University

Abstract

Background: Breast cancer is a leading cause of death among women globally. Mammography and ultrasound, guided by the Breast Imaging Reporting and Data System (BI-RADS), are critical tools for distinguishing benign from malignant breast lesions. Advances in molecular subtyping, including lu-minal subtypes, HER2-enriched, and triple-negative breast can-cer (TNBC), have revolutionized breast cancer management by enabling personalized treatment. Aim of Study: The aim of this study is to use ultrasound and mammographic morphological features predictors of biological markers in patients with breast cancer. Patients and Methods: This retrospective study involved 57 female patients with histopathologically confirmed malignant breast lesions. All patients underwent standard mammography and high-resolution ultrasound, followed by ultrasound-guided core biopsies. Immunohistochemical analysis determined hor-mone receptor status, including estrogen receptor (ER), pro-gesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). The Allred scoring system evaluated ER/ PR expression, and equivocal HER2 cases underwent fluores-cence in situ hybridization (FISH) testing. Statistical analysis was conducted using RStudio, with p<0.05 deemed significant. Results: Imaging features correlated significantly with mo-lecular subtypes. Luminal subtypes showed irregular shapes, spiculated margins, hypoechoic echo patterns, and posterior shadowing (p<0.001). HER2-enriched lesions were associated with suspicious calcifications (p=0.002). TNBC presented with round shapes and circumscribed margins, mimicking benign lesions (p<0.001). Conclusion: Molecular subtypes of malignant breast le-sions can often be predicted by specific imaging features on mammography and ultrasound. However, histopathological confirmation remains essential. Radiologists must recognize that aggressive subtypes like TNBC may exhibit benign imag-ing appearances, emphasizing the need for integrating imaging and pathological findings for accurate diagnosis and optimal management.

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