Value of Breast Ultrasound in the Prediction of Molecular Subtypes in Patients with Breast Cancer

Objectives : To correlate between the breast ultrasound imaging features and molecular subtypes of breast cancer and to assess the predictive value of their correlation. Background : Molecular subtyping of breast cancer has become the standard of care in breast cancer management. Survival, pattern of recurrence, and treatment response vary between different molecular subtypes. Patients and methods : This prospective cross-sectional study included all consecutive female patients referred to the Radiology Department from January 2020 to April 2022 who underwent breast ultrasound and surgical excision followed by histopathology and immunohistochemistry of the surgical specimen. Results : A total of 105 patients with pathologically proven breast cancer were included. Multifocal tumors with cal-ci fi cations were strongly associated with human epidermal growth receptor 2-positive tumors, with a P value of less than 0.001. Lesions with noncircumscribed margins and posterior acoustic shadowing were more likely to be luminal A (LA) or luminal B (LB) subtype, with a P value of less than 0.001, and a tendency of luminal B tumors to elicit high-grade vascularity on color and power Doppler. Lesions with circumscribed margins and posterior acoustic enhancement were signi fi cantly more likely to be triple-negative breast cancer, with a P value of less than 0.001, and a higher tendency for older age and larger mean tumor diameter compared with non-triple-negative breast cancer groups. Conclusion : Certain ultrasound imaging characteristics like tumor margins, posterior acoustic features, vascularity on color Doppler, and calci fi cations are highly predictive of certain molecular subtypes of breast cancer, further expanding the role of ultrasound and potentially enhancing patient outcome by accelerating diagnosis and treatment.