Radiology–pathology correlation of hormonal subtypes of breast cancer based on mammography, ultrasound, and PET imaging

Breast cancer is one of the most common cancers among the female population globally and a major cause of death due to cancers among women. It has been classified into histopathological, hormonal, and molecular subtypes based on hormone receptor status. Their management involves a multidisciplinary approach depending on these subtypes, TNM staging, tumour size, and site. The purpose of this study was to assess the correlation between ultrasound and mammography characteristics and the maximum standardized uptake value on PET with hormonal subtypes of breast cancer.

It was a retrospective study from a single-centre data available for 8 months. In this study, 5 hormonal subtypes were considered; Luminal A, Luminal B, Luminal HER2-positive subtype, HER2-enriched subtype, and triple-negative subtype. The morphology of the lesions analysed on mammography and sonography and the SUV max value on PET were considered for analyses. The prediction performance of these features for the hormonal subtypes of breast cancers was then analysed.

Luminal A and B subtypes of breast cancer had indistinct margins with posterior acoustic shadowing on ultrasound. Triple-negative subtypes were well-circumscribed lesions with posterior acoustic enhancement on ultrasound. HER2-positive lesions characteristically had pleomorphic microcalcifications with mixed posterior acoustic features on mammography. On PET, HER2-enriched cases had the highest SUV, and the Luminal A subtype had the lowest SUV.

According to our observations, there are certain typical morphological imaging characteristics for each hormonal subtype of breast cancer. These imaging modalities may help radiologists and clinicians in stratifying their patients for prognostication and better management.