Imaging the invisibility: Predicting histopathology through mammographic clues in invasive breast cancer

Breast cancer (BC) is the most common malignancy in women worldwide. Mammographic screening reduces BC mortality across populations, although tumors show intratumoral heterogeneity and diverse imaging patterns. Different clinical and pathological characteristics yield variable mammographic appearances, influencing patient prognosis. Key biomarkers-ER, PR, HER2/neu, and Ki67-are linked to tumor behavior, treatment outcomes, and response to targeted therapies. This study aimed to assess the correlation between mammographic appearance and histopathological features in invasive breast carcinoma.

A retrospective review (2019-2023) analysed the records of breast cancer patients. The data included demographics (age, menopausal status), mammographic findings (patterns, morphology, margins, mass, calcifications, focal asymmetric density), and pathological features (histology, grade, ER/PR/HER2, Ki-67, LVSI, PNI, tumor size, nodal status). Statistical analysis was performed via chi-square tests and Student's t tests.

Retrospective data from 122 patients were collected. The majority of patients were postmenopausal, with a mean age of 51 years. In the mammograms, 77% had fibroglandular to heterogeneous density with irregular morphological patterns and spiculated margins. Histologically, 82% of patients were proven to have invasive ductal carcinoma. Seventy percent of patients with spiculated masses had increased expression of ER and PR and low ki67%. There was a positive correlation between size on mammogram and tumor grade. Calcification is significant in Her 2-positive patients.

Understanding the correlation between mammographic findings and histopathological reports can help in deciding the course of neoadjuvant therapy in the management of breast cancer, which may help improve outcomes.