Characteristics of breast cancers detected by ultrasound screening in women with negative mammograms

Abstract

Screening ultrasound (US) can increase the detection of breast cancer. However, little is known about the clinicopathologic characteristics of breast cancers detected by screening US. A search of the database for patients with breast cancer yielded a dataset in 6837 women who underwent breast surgery at Seoul National University Hospital (Korea). Of 6837 women, 1047 were asymptomatic and had a non-palpable cancer. Two hundred fifty-four women with 256 cancers detected by US (US-detected cancer) and 793 women with 807 cancers detected by mammography (MG-detected cancer) were identified. The imaging, clinicopathologic, and molecular data were reviewed. Univariate and multivariate analyses were carried out. Women with US-detected cancer were younger and were more likely to undergo breast-conserving surgery and to have node-negative invasive cancer (P < 0.0001). By multivariate analysis, the significant independent characteristics were tumor size, mammographic density, final assessment category according to the American College of Radiology Breast Imaging Reporting and Data System, progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and molecular subtype. Compared to tumors that were > 2 cm in size, tumors that were ≤ 1 cm in size were 2.2-fold more likely to be US-detected cancers (P = 0.02). Compared to the luminal A subtype tumors (estrogen receptor [ER]+, PR+, HER2-), luminal B subtype tumors (ER+, PR+, HER2+) were less likely to be in the US-detected cancer group (P < 0.01). Women with dense breasts were more likely to have US-detected cancer (P < 0.01) versus those with non-dense breasts. Screening US-detected cancers were less likely to be diagnosed as category 5 instead of category 4 (P < 0.01). In conclusion, women with US-detected breast cancer are more likely to have small-sized invasive cancer and more likely associated with the luminal A subtype.