Abstract

Author(s): Hiba Mohammed Abdulwahid, Wijdan Hamza Al-Dabbagh, Sana Nadhir

Now a day, Breast Cancer (BC) is the most common cancer over the world. GLOBOCAN reported more than 2.2 million new cases of BC in 2020. Radiological appearance including ultrasonography and mammography may provide prognostic and predictive useful data when correlate with the histopathological appearances which have significance potential values that could be influence the management of BC. The aimed to correlate radiologic appearance of ultrasonography and mammography of breast cancer to the histopathologic features. A retrospective study reviewed 103 Iraqi females which histologically confirmed and diagnosed with BC. This study conducted in period between January 2019 and January 2020. The demographic data, histopathologic features, and details of the primary tumor were recorded. The following variables were studied: age, staging, histopathology, grading, DCIS, ER, PR, HER2neu, extensive intraductal component, resection margin status, differentiation, lymphovascular invasion, and location of mass. All breast ultrasound and mammographic examinations were performed. Then the radiological presentations were correlated with histopathologic appearances. The mean age of patients was 51.53 ± 10.974 years and left side BC was mostly recorded. The mass in ultrasound tumor detected in 92.3%, with irregular shape, spiculated or indistinct margins. In relation to mammographic findings, the mass detected in 92(89.3%) with irregular figure, and spiculated or indistinct margins. The distortion architecture is found in 44.7%, and microcalcification presented in 40.8% of mammography. The most common histopathology was IDC, Grade II and moderately differentiation. DCIS was figured in 48(46.6%) of specimens. Lymph nodes were positive in 51.5%. ER and PR were positive in 78.6%, and HER2neu was negative in 63.1%. Free resectable surgical margins were recorded in 89(86.4%) of reports. The LV invasion documented in 39.8%. The ultrasound mass is mainly detect in middle age group of irregular shape and indistinct margin. While mammographic mass detect in younger age group with irregular shape and without specific margin. Women with right side tumor were more likely to have IDC, grade II, with moderately differentiation, and more expressed negative HER2neu (p=0.043). Also, right side BC was more likely to have DCIS and LN positive (p=0.041, p=0.015) than left side. Mass in mammography is more likely to be IDC (p<0.0001) that have CIS feature (p=0.003), with LN positive (p=0.035) and LV invasion (p=0.047). The irregular shape of IDC was more exhibit (p=0.009). The distortion sign is more evident in IDC, atypical lobular appearance, associated LCIS, and positive surgical margin. IDC and CIS of mammography were more likely to showed microcalcification (p<0.0001). To our knowledge, this is the first time study conduct in Iraq discusses the association between radiological features including breast ultrasonography and mammography with corresponding histopathologic appearances. The irregular mass, spiculated or indistinct margins are the most common radiologic presentations. Irregular and indistinct margin of masses are mostly presented in middle age groups. The right side tumor is more likely to detected with irregular shape mass, IDC, grade II, with moderately differentiation, and more expressed negative HER2neu than left side. Mass correlate to have CIS feature, with LN positive and LV invasion is malignant.

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