Contrast Enhanced Mammography for the Non-Invasive Differentiation of Breast Cancer Molecular Subtypes and Tumor Grade

Background: Breast cancer is a heterogenous disease with different molecular subtypes. Each molecular subtype has its own prognosis and management. Identifying this molecular subtype is necessary to allow individualized patient treatment. CESM has the potential to non-invasively differentiate the various molecular subtypes of breast cancer. In this manner it can provide information about the tumoras a wholenot just the biopsied part of the tumor. Aim of Study: Assess Contrast enhanced spectral mammography as a non-invasive imaging tool in predicting molecular subtypes of breast cancer and tumor grade. Patients and Methods: This study includes 95 female patients with 98 breast lesions in the time period from January 2021 to February 2022. All breast lesions were assessed by Digital mammography and ultrasound, followed by contrast mammography. Biopsy was then performed (BIRADS 4&5) to identify the pathologic type and tumor grade followed by immunohistochemistry to identify the molecular subtype of each tumor. The dominant feature of each molecular subtype on contrast mammography was recorded regarding lesion morphology (mass/distortion/asymmetry/pathological microcal-cification/lesion margins) and pattern of enhancement. Results: Chi square ( x 2) test shows a significant association between lesion margins and the various molecular subtypes of breast cancer ( p =0.014). It also shows a significant association between molecular subtype and tumor grade ( p =0.018). However, the enhancement pattern didn't reflect a significant association to the molecular subtypes ( p =0.101 for mass enhancement and 0.419 for NME)