Abstract
Ultrasound is a useful adjunct to mammography for the characterisation and biopsy of solid breast lesions. Protein expression profiling of breast cancer has identified specific subgroups with potential clinical, biological and therapeutic implications. The aim of this study was to determine the ultrasound correlates of these novel molecular classes of invasive breast cancer. The ultrasound findings in 358 patients with operable breast cancer were correlated with the previously described protein expression classes identified by our group using immunohistochemical (IHC) assessment of a large series of breast cancer cases in which 25 proteins of known relevance in breast cancer were assessed, including hormone receptors, HER2 status, basal and luminal markers, p53 and e-cadherin. The proportion of occult lesions was not significantly different in the two groups. Significant differences were noted between the two groups expressing luminal epithelial markers and hormone receptors (1 and 2), including a greater proportion of ill-defined, irregular and distally attenuating tumours in group 2. Tumours characterised by c-erbB2/MUC1 expression, with weak hormone receptor positivity (group 3) were also more likely to be ill defined. Tumours expressing basal markers (group 5) were less likely to have an echogenic halo. The ultrasound features of breast cancer show areas of significant correlation with molecular classes of invasive breast cancer identified by IHC analysis. The biological reasons for these findings and their implications regarding imaging protocols require further study and may enable improved detection of these lesions.
Similar content being viewed by others
References
Ellis IO, Galea M, Broughton N et al (1992) Pathological prognostic factors in breast cancer. II. Histological type. Relationship with survival in a large study with long-term follow-up. Histopathology 20:479–89
Galea MH, Blamey RW, Elston CW et al (1992) The Nottingham Prognostic Index in primary breast cancer. Br Cancer Res Treat 22:207–219
Blamey RW, Ellis IO, Pinder SE et al (2007) Improvement in case survival in breast cancer across the prognostic spectrum: effect on the Nottingham Prognostic Index. Eur J Cancer 43:1548–1555
Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410
Carter CL, Allen C, Henson DE (1989) Relation of tumour size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 63(1):181–187
Lee AHS, Pinder SE, Macmillan RD et al (2006) Prognostic value of lymphovascular invasion in women with lymph node negative invasive breast carcinoma. Eur J Cancer 42:357–362
Rakha E, Ellis IO (2007) An overview of assessment of prognostic and predictive factors in breast cancer needle core biopsy specimens. J Clin Pathol 60(12):1300–1306
Tabar L, Duffy SW, Vitak B et al (1999) The natural history of breast cancer—what have we learned from screening? Cancer 86:449–462
Alizadeh AA, Ross DT, Perou CM et al (2001) Towards a novel classification of human malignancies based on gene expression patterns. J Pathol 195(1):41–52
Abd El-Rehim DM, Ball G et al (2005) High-throughput protein expression analysis using tissue microarray technology of a large well-characterised series identifies biologically distinct classes of breast cancer confirming recent cDNA expression analyses. Int J Cancer 116(3):340–350
Stavros AT, Thickman D, Rapp CL et al (1995) Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology 196:113–123
Lamb PM, Perry NM, Vinnicombe SJ et al (2000) Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Rad 55:40–44
Kim TH, Kang DK, Kim SY et al (2008) Sonographic differentiation of benign and malignant papillary lesions of the breast. J Ultrasound Med 27:75–82
Skaane P, Skjørten F (1999) Ultrasonographic evaluation of invasive lobular carcinoma. Acta Radiol 40(4):369–375
Günhan-Bilgen I, Oktay A (2007) Tubular carcinoma of the breast: mammographic, sonographic, clinical and pathologic findings. Eur J Radiol 61(1):158–162
Kim SH, Seo BK, Lee J et al (2008) Correlation of ultrasound findings with histology, tumour grade, and biological markers in breast cancer. Acta Oncol Mar 6:1–8
Rotstein AH, Neerhut PK (2005) Ultrasound characteristics of histologically proven grade 3 ductal breast carcinoma. Australas Radiol 49:476–479
Mesurolle B, Kadoch L, El-Khoury M et al (2007) Sonographic features of breast carcinoma presenting as masses in BRCA gene mutation carriers. J Ultrasound Med 26(6):817–824
Schrading S, Kuhl CK (2008) Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology 246(1):58–70
Guarino M, Rubino B, Ballabio G (2007) The role of epithelial–mesenchymal transition in cancer pathology. Pathology 39(3):305–318
Butler RS, Venta LA, Wiley EL et al (1999) Sonographic evaluation of invasive lobular carcinoma. Am J Radiol 172:325–330
Sheppard DG, Whitman GJ, Huynh PT et al (2000) Tubular carcinoma of the breast: mammographic and sonographic features. Am J Radiol 174:253–257
Taneja S, Evans AJ, Rakha EA et al (2008) The mammographic correlations of a new immunohistochemical classification of invasive breast cancer. Clin Radiol 63(11):1228–1235
Evans AJ, Rakha EA, Pinder SE et al (2007) Basal phenotype: a powerful prognostic factor in small screen-detected invasive breast cancer with long-term follow up. J Med Screen 14(4):210–214
Sarrió D, Rodriguez-Pinilla SM, Hardisson D et al (2008) Epithelial–mesenchymal transition in breast cancer relates to the basal-like phenotype. Cancer Res 68(4):989–997
Evans AJ, Pinder SE, James JJ et al (2006) Is mammographic spiculation an independent, good prognostic factor in screening-detected invasive breast cancer. Am J Radiol 187(5):1377–1380
Phillips KA (2000) Immunophenotypic and pathologic differences between BRCA1 and BRCA2 hereditary breast cancers. J Clin Oncol 18:107s–112s
Tilanus-Linthorst M, Verhoog L, Obdeijn I-M et al (2002) A BRCA 1/2 mutation, high breast density and prominent pushing margins contribute to a frequent false negative mammography. Int J Cancer 102:91–95
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Au-Yong, I.T.H., Evans, A.J., Taneja, S. et al. Sonographic correlations with the new molecular classification of invasive breast cancer. Eur Radiol 19, 2342–2348 (2009). https://doi.org/10.1007/s00330-009-1418-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-009-1418-2