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01-08-2013 | Breast

Mammographic features of calcifications in DCIS: correlation with oestrogen receptor and human epidermal growth factor receptor 2 status

Authors: Min Sun Bae, Woo Kyung Moon, Jung Min Chang, Nariya Cho, So Yeon Park, Jae-Kyung Won, Yoon-Kyung Jeon, Hyeong-Gon Moon, Wonshik Han, In Ae Park

Published in: European Radiology | Issue 8/2013

Abstract

Objective

This study investigated the correlation of oestrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status with the probability of malignancy (POM) of mammographic calcifications in ductal carcinoma in situ (DCIS).

Methods

A total of 101 women (age range, 27–83 years) with pure DCIS that presented as mammographic calcifications were included. Three radiologists independently reviewed mammograms according to the BI-RADS lexicon and provided 100-point POM scores and a BI-RADS category. ER, HER2 and breast cancer subtypes were determined using immunohistochemistry (IHC) and fluorescence in situ hybridisation. Pairwise correlations between POM and IHC biomarker scores were calculated, and mammographic features were compared between breast cancer subtypes.

Results

HER2 level positively correlated with the POM score (P < 0.0001) and BI-RADS category (P < 0.0001), and ER level inversely correlated with the POM score (P < 0.013) and BI-RADS category (P < 0.010). Fine linear branching (P = 0.004) and segmental (P = 0.014) calcifications were significantly associated with HER2-positive cancers, and clustered calcifications were more frequently observed in ER-positive cancers (P = 0.014).

Conclusion

HER2 status in DCIS correlated positively with the POM of mammographic calcifications, as determined by radiologists on the basis of the BI-RADS lexicon.

Key Points

• Prediction of malignancy on mammographic ductal carcinoma in situ is difficult.

• HER2 level correlated positively with the probability of malignancy assigned by radiologists.

• ER level correlated inversely with the probability of malignancy assigned by radiologists.

• HER2-positive DCIS more frequently exhibited fine linear branching or segmental calcifications.

• ER-positive DCIS more frequently exhibited clustered calcifications.

Kerlikowske K (2010) Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr 41:139–141CrossRef

Allred DC (2010) Ductal carcinoma in situ: terminology, classification, and natural history. J Natl Cancer Inst Monogr 41:134–138CrossRef

Burstein HK, Polyak K, Wong JS et al (2004) Ductal carcinoma in situ of the breast. N Engl J Med 350:1430–1441PubMedCrossRef

Erbas B, Provenzano E, Armes J et al (2006) The natural history of ductal carcinoma in situ of the breast: a review. Breast Cancer Res Treat 97:135–144PubMedCrossRef

D’Orsi CJ (2010) Imaging for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr 41:214–217CrossRef

Holmes P, Lloyd J, Chervoneva I et al (2011) Prognostic markers and long-term outcomes in ductal carcinoma in situ of the breast treated with excision alone. Cancer 117:3650–3657PubMedCrossRef

Han K, Nofech-Mozes S, Narod S et al (2012) Expression of HER2neu in ductal carcinoma in situ is associated with local recurrence. Clin Oncol (R Coll Radiol) 24:183–189CrossRef

Shao W, Brown M (2012) Advances in estrogen receptor biology: prospects for improvements in targeted breast cancer therapy. Breast Cancer Res 6:39–52CrossRef

Provenzano E, Hopper JL, Biles GG et al (2003) Biological markers that predict clinical recurrence in ductal carcinoma in situ of the breast. Eur J Cancer 39:622–630PubMedCrossRef

10.

Rubin I, Yarden Y (2001) The basic biology of HER2. Ann Oncol 12:S3–S8PubMedCrossRef

11.

Leonard GD, Swain SM (2004) Ductal carcinoma in situ, complexities and challenges. J Natl Cancer Inst 96:906–920PubMedCrossRef

12.

Polyak K (2010) Molecular markers for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr 41:210–213CrossRef

13.

Perou CM, Sorlie T, Eisen MB et al (2000) Molecular portraits of human breast tumours. Nature 406:747–752PubMedCrossRef

14.

Weigel S, Decker T, Korsching E, Hungermann D, Böcker W, Heindel W (2010) Calcifications in digital mammographic screening: improvement of early detection of invasive breast cancers? Radiology 255:738–745PubMedCrossRef

15.

Holland R, Schuurmans Stekhoven JH, Hendriks JHCL, Vebeek ALM, Mravunac M (1990) Extent, distribution, and mammographic/histologic correlations of breast ductal carcinoma in situ. Lancet 335:519–522PubMedCrossRef

16.

Dershaw DD, Giess CS, McCormick B et al (1997) Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence. Cancer 79:1355–1361PubMedCrossRef

17.

Antonio AL, Crespi CM (2010) Predictors of interobserver agreement in breast imaging using the Breast Imaging Reporting and Data System. Breast Cancer Res Treat 120:539–546PubMedCrossRef

18.

Badra FA, Karamouzis MV, Ravazoula P et al (2006) Non-palpable breast carcinomas: correlation of mammographically detected malignant-appearing microcalcifications and epidermal growth factor receptor (EGFR) family expression. Cancer Lett 244:34–41PubMedCrossRef

19.

Karamouzis MV, Likaki-Karatza E, Ravazoula P et al (2002) Non-palpable breast carcinomas: correlation of mammographically detected malignant-appearing microcalcifications and molecular prognostic factors. Int J Cancer 102:86–90PubMedCrossRef

20.

Gajdos C, Tartter PI, Bleiweiss IJ et al (2002) Mammographic appearance of nonpalpable breast cancer reflects pathologic characteristics. Ann Surg 235:246–251PubMedCrossRef

21.

Seo BK, Pisano ED, Kuzimak CM et al (2006) Correlation of HER-2/neu overexpression with mammography and age distribution in primary breast carcinomas. Acad Radiol 13:1211–1218PubMedCrossRef

22.

Evans AJ, Pinder SE, Ellis IO et al (1994) Correlations between the mammographic features of ductal carcinoma in situ (DCIS) and C-erbB-2 oncogene expression. Clin Radiol 49:559–562PubMedCrossRef

23.

Wang Y, Ikeda DM, Narasimhan B et al (2008) Estrogen receptor-negative invasive breast cancer: imaging features of tumors with and without human epidermal growth factor receptor type 2 overexpression. Radiology 246:367–375PubMedCrossRef

24.

American College of Radiology (2003) Breast Imaging Reporting and Data System (BI-RADS) (4th edition): mammography. American College of Radiology, Reston

25.

Ohlschlegel C, Zahel K, Kradolfer D et al (2011) HER2 genetic heterogeneity in breast carcinoma. J Clin Pathol 64:1112–1116PubMedCrossRef

26.

Wolff AC, Hammond ME, Schwartz JN et al (2007) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol 25:118–145PubMedCrossRef

27.

Allred DC, Wu Y, Mao S et al (2008) Ductal carcinoma in situ and emergence of diversity during breast cancer evolution. Clin Cancer Res 14:370–378PubMedCrossRef

28.

Hannemann J, Velds A, Halfwerk JB, Kreike B, Peterse JL, van de Vijver MJ (2006) Classification of ductal carcinoma in situ by gene expression profiling. Breast Cancer Res 8:R61PubMedCrossRef

29.

Bent CK, Bassett LW, D’Orsi CJ, Sayre JW (2010) The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories. AJR Am J Roentgenol 194:1378–1383PubMedCrossRef

30.

Wiechmann L, Kuerer HM (2008) The molecular journey from ductal carcinoma in situ to invasive breast cancer. Cancer 112:2130–2142PubMedCrossRef

31.

Tsikitis VL, Chung MA (2006) Biology of ductal carcinoma in situ classification based on biologic potential. Am J Clin Oncol 29:305–310PubMedCrossRef

32.

Evans A, Pinder S, Wilson R et al (1994) Ductal carcinoma in situ of the breast: correlation between mammographic and pathologic findings. AJR Am J Roentgenol 162:1307–1311PubMedCrossRef

33.

Dinkel HP, Gassel AM, Tschammler A (2000) Is the appearance of microcalcifications on mammography useful in predicting histological grade of malignancy in ductal cancer in situ? Br J Radiol 73:938–944PubMed

34.

McCaskill-Stevens W (2010) National Institutes of Health state-of-the-science conference on the management and diagnosis of ductal carcinoma in situ: a call to action. J Natl Cancer Inst Monogr 2010:111–112PubMedCrossRef

35.

Wang SY, Shamliyan T, Virnig BA, Kane R (2011) Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Breast Cancer Res Treat 127:1–14PubMedCrossRef

36.

Kerlikowske K, Molinaro AM, Gauthier ML et al (2010) Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. J Natl Cancer Inst 102:627–637PubMedCrossRef

37.

Rakovitch E, Nofech-Mozes S, Hanna W et al (2012) HER2/neu and Ki67 expression predict non-invasive recurrence following breast-conserving therapy for ductal carcinoma in situ. Br J Cancer 106:1160–1165PubMedCrossRef

38.

Allred DC, Anderson SJ, Paik S et al (2012) Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol 30:1268–1273PubMedCrossRef

39.

Kane RL, Virnig BA, Shamliyan T et al (2010) The impact of surgery, radiation, and systemic treatment on outcomes in patients with ductal carcinoma in situ. J Natl Cancer Inst Monogr 41:130–133CrossRef

40.

Sharma A, Koldovsky U, Xu S et al (2012) HER-2 pulsed dendritic cell vaccine can eliminate HER-2 expression and impact ductal carcinoma in situ. Cancer 118:4354–4362PubMedCrossRef

41.

Tamimi RM, Baer HJ, Marotti J et al (2008) Comparison of molecular phenotypes of ductal carcinoma in situ and invasive breast cancer. Breast Cancer Res 10:R67–R76PubMedCrossRef

42.

Kojima Y, Tsunoda H, Honda S et al (2011) Radiographic features for triple negative ductal carcinoma in situ of the breast. Breast Cancer 18:213–220PubMedCrossRef

43.

Yang WT, Dryden M, Broglio K et al (2008) Mammographic features of triple receptor-negative primary breast cancers in young premenopausal women. Breast Cancer Res Treat 111:405–410PubMedCrossRef

Title: Mammographic features of calcifications in DCIS: correlation with oestrogen receptor and human epidermal growth factor receptor 2 status
Authors: Min Sun Bae
Woo Kyung Moon
Jung Min Chang
Nariya Cho
So Yeon Park
Jae-Kyung Won
Yoon-Kyung Jeon
Hyeong-Gon Moon
Wonshik Han
In Ae Park
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 8/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-2827-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mammographic features of calcifications in DCIS: correlation with oestrogen receptor and human epidermal growth factor receptor 2 status

Abstract

Objective

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key Points

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