Correlations Between Ultrasonographic Findings of Invasive Lobular Carcinoma of the Breast and Intrinsic Subtypes

Abstract

Purpose To analyze the ultrasonographic findings of invasive lobular carcinoma (ILC) of the breast in 360 women and the correlations between the characteristics and the intrinsic subtypes.

Materials and Methods We evaluated the imaging findings according to the lexicon of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). The included ultrasonographic features were shape, orientation, margin, echo pattern, posterior features, calcifications, the vascularity of the masses and the presence of architectural distortions. The associations between those features and the intrinsic ILC subtypes were investigated.

Results The most common manifestations of ILC on ultrasound (US) were hypoechoic masses with irregular shape, parallel orientation, spiculated margin, posterior acoustic shadowing, no calcification and blood vessels in the rim. The patients in the luminal A subtype were the youngest, and the patients in the HER2 overexpression subtype were the oldest (p = 0.01). On US, the HER2 overexpression subtype was characterized by microlobulated margins (p = 0.002), while the luminal A subtype and the luminal B subtype mostly had spiculated margins. The basal-like subtype was distinctive in that it had no posterior features (p = 0.041), rather than acoustic shadowing, and the masses in the HER2 and basal-like subtypes were larger than in the other two groups (p = 0.03).

Conclusion There were significant differences and several trends in the ultrasonographic characteristics of different intrinsic subtypes, which may supply accurate imaging diagnostic criteria to assist in the management of individuals with ILC.

Zusammenfassung

Ziel Untersuchung der Ultraschallbefunde des invasiven lobulären Karzinoms (ILC) der Brust bei 360 Frauen, sowie die Zuordnung der Charakteristika zu den intrinsischen Subtypen.

Materialien und Methoden Wir haben die Ergebnisse der Bildgebung nach dem Atlas der BI-RADS („American College of Radiology Breast Imaging Reporting and Data System“) ausgewertet. Die eingeschlossenen Ultraschallmerkmale waren Form, Ausrichtung, Rand, Echomuster, posteriore Merkmale, Verkalkungen, die Vaskularität der Herdläsionen und das Auftreten von Architekturstörungen. Der Zusammenhang dieser Merkmale mit den intrinsischen ILC-Subtypen wurde untersucht.

Ergebnisse Die häufigsten Manifestationen des ILC im Ultraschall (US) waren Echo-arme Herdläsionen mit irregulärer Form, paralleler Ausrichtung, spikuliertem Rand und posteriorem Schallschatten, keine Verkalkung und Blutgefäße im Randbereich. Patienten mit luminalem Subtyp-A waren die jüngsten und diejenigen Patienten mit HER2-Überexpression-Subtyp waren die ältesten (p = 0,01). Im US war der HER2-Überexpression-Subtyp durch mikrolobulierte Ränder gekennzeichnet (p = 0,002), während die luminalen Subtypen A und B meist spikulierte Ränder aufwiesen. Der „basal-like“ Subtyp war hingegen dadurch charakterisiert, dass er außer einem Schallschatten keine posterioren Merkmale (p = 0,041) aufwies. Außerdem waren die Herdbefunde bei den Subtypen HER2 und „basal-like“ größer als bei den beiden anderen Gruppen (p = 0,03).

Schlussfolgerung Die verschiedenen intrinsischen Subtypen zeigten bezüglich der US-Charakteristika signifikante Unterschiede sowie einige Tendenzen. Diese könnten somit genaue diagnostische Bildgebungskriterien liefern, um das Patientenmanagement bei ILC zu unterstützen.

Key words

invasive lobular carcinoma - ultrasound - BI-RADS - correlations - intrinsic subtype

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