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The potential association between degree of mammographic spiculation and prognosis
Li Sturesdotter1,2, Hanna Sartor3,4, Hedvig Kristensson3
1Diagnostic Radiology, Translational Medicine, Lund University, Lund, Sweden. li.sturesdotter@med.lu.se.
Objectives:
Mammographically spiculated breast cancer is frequently less aggressive than cancers with alternative appearances. This study aims to investigate whether the degree of spiculations relative to the tumor mass on mammography, termed the spic mass ratio (SMR), is associated with breast cancer characteristics and survival.
Materials And Methods:
This retrospective exploratory single-center study analyzed mammograms from 161 women with spiculated breast cancer in the Malmö Diet and Cancer Study cohort (2004-2014). Radiologists segmented the tumor mass and the spiculation areas. The SMR was calculated by dividing the combined tumor and spiculation area by the tumor area alone. The subjects were stratified into tertiles with low, medium, and high SMR. The study examined associations between SMR and breast density, mode of detection, age, tumor size, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, Ki67, histological grade, axillary lymph node involvement (ALNI), histological type, and breast cancer-specific survival, utilizing the Chi-squared test, ANOVA, Fisher's exact test, Kaplan-Meier curves, and Cox regression.
Results:
The mean age was 68 years (range 55-91). SMR was statistically significantly associated with both age and breast density. No other significant associations were observed. Among the nine women with the highest SMR values, axillary lymph node negativity, estrogen positivity, and an overall low Ki67 index were noted.
Conclusions:
The SMR, representing the degree of spiculations relative to tumor mass, was not significantly associated with breast cancer survival or ALNI. Further research is necessary to explore the prognostic implications of extensive spiculations in spiculated breast cancer.
Critical Relevance Statement:
The degree of spiculation relative to the tumor mass is an unexplored mammographic feature that can be measured subjectively, as in this study. Extensive spiculation was associated with higher age and lower breast density. No certain conclusions could be drawn regarding the impact on breast cancer survival.
Key Points:
The degree of spiculation relative to the tumor mass on mammography is an unexplored mammographic feature. A high ratio of spiculations in relation to tumor mass was associated with higher age and lower breast density. The nine women with a very high spiculation to tumor mass ratio were all axillary lymph node negative.
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