Tehran University of Medical Sciences
To evaluate the ultrasound features of solid malignant masses detected in the US with different hormonal (ER/PR) status and HER 2 sub-types in various age groups (under 35, 36 to 50 and over 51).
Patients and Methods:
High-resolution US images of 160 consecutive cases of solid masses with final pathology of invasive ductal carcinoma ( IDC ) analyzed and correlated with pathology and biomarkers.
Comparing different age groups there was a significant difference between cancerous masses in terms of margin (p=0.0001), shape (p=0.018), and orientation (p=0.037).
The irregularly shaped cancers were significantly higher in the over 35 and the round shaped ones were more prevalent in age over 51 (p=036).
In the case of margin, there was no malignant with speculated/angular margin at age under 35 years. On the other hand, in over 51 years, the speculated margin was more common (23.1%). Malignant masses with circumscribed margin were significantly higher in patients’ age under 35. Parallel malignant masses were significantly more prevalent in younger than 35. In elder cases, nonparallel malignant masses were more frequent.
There was a significant difference between the margin and shape of the masses with the ER/PR status (P=0.045); ER-positive malignant masses showed commonly indistinct border (57/116,49.1%) while the most of ER-negative tumors showed micro lobulated edge(15/35,39.5%).
In overall, in both groups, the masses were more irregular, but in the ER-negative group, this was significantly higher ( 66.4% vs. 47.4%).
The number of round masses was also significantly higher in the hormone negative group (7/38, 18.4% vs. 7/116, 6%).
HER 2 positive masses were further heterogeneous
(53.7%, 58/108) with the p-value of 0.076.
The HER 2 positive cancers had grade III (39/99(39.4%) vs. 27/44(61.4%)) with a significant analytical difference. Few of the HER 2 positive group had Grade 1, while this level was significantly higher in HER 2 negative group (P=0.004).
In term of mass size, ER-positive cancers were discovered in smaller sizes than negative types (P=0.035).
Most of the patients under age 35 were ER/PR negative (57.8%).In age over 36, most of them were ER/PR positive in 82.7% and 75.8% respectively. This difference was significant (p<0.0001).
Tumors were mostly graded of 3 in age over 50 (48.6%). At the age of under 35, there were more grade 3 also (16/23, 69.5%).
ER-negative breast tumors were mostly with the microlobulated margin with a higher interest in displaying round or oval/lobulated shapes.
ER-positive cancers are mostly demonstrated masses with indistinct margin and irregularly shaped. Larger Pseudo-benign appearing features are more common in ER-negative cancers which may be due to its higher vascularity and less fibrosis component.