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Published on: August 1, 2018
Subtype-specific sonographic signatures and clinicopathological features of metaplastic breast cancer: a 50-case
Boxiong Wei1, Zijing Fu1, Yuhong Shao1
1Department of Ultrasound, Peking University First Hospital, Beijing, China.
Background:
Metaplastic breast cancer (MBC) is a rare, aggressive malignancy with profound histological heterogeneity. This study aimed to describe the subtype-specific sonographic signatures and baseline clinicopathological features of MBC based on the World Health Organization classification.
Methods:
This exploratory single-center retrospective cohort study included 50 women with histologically confirmed MBC (15 spindle cell, 12 squamous cell, and 23 mixed type) treated between January 2010 and January 2026. Preoperative ultrasound features, evaluated via BI-RADS criteria, and baseline clinicopathological parameters were compared across subtypes.
Results:
The spindle cell subtype frequently presented with a pseudo-benign sonographic phenotype, characterized by circumscribed margins (60.0%) and oval or round shape (46.7%), along with significantly smaller tumor dimensions (median 3.1 cm; p = 0.041). Conversely, squamous cell and mixed-type tumors more often showed heterogeneous echogenicity (83.3 and 73.9%, respectively; p = 0.003) and complex cystic-solid components (75.0 and 56.5%, respectively; p = 0.037), which may reflect cystic degeneration or necrosis. In addition, a descriptive pattern suggesting size-node dissociation was observed: despite a large mean primary tumor size of 4.7 cm, the overall axillary lymph node metastasis rate was 22.0%, with similar rates in tumors measuring 2-5 cm and >5 cm (26.1 and 23.8%, respectively).
Conclusion:
MBC demonstrates significant subtype-specific heterogeneity. The pseudo-benign sonographic appearance of the spindle cell subtype represents a major diagnostic pitfall, supporting prompt biopsy for rapidly enlarging lesions. The observed size-node pattern should be interpreted as descriptive and hypothesis-generating, because nodal events were limited and long-term survival, recurrence, and distant metastasis data were unavailable. Recognizing these distinct patterns may facilitate accurate diagnosis and timely multidisciplinary management.