Contrast-enhanced mammography based quantitative and qualitative feature analysis across different breast cancer molecular subtypes

OBJECTIVE: To investigate the imaging manifestations of different molecular subtypes of breast cancer (BC) by contrast enhanced mammography (CEM). METHODS: From April 2019 to January 2022, 183 BC patients with suspected malignant mass underwent CEM examination were included. The differences in imaging features among different subtypes of breast cancer, as well as the detailed correlations, were determined using chi-square test, cross-contingency table method, and multivariate logistic analysis. RESULTS: There were significant differences among four BC molecular subtypes in terms of lesion size (C = 0.306, P = 0.003), morphology (C = 0.296, P = 0.000), enhancement pattern (C = 0.461, P = 0.000), time-gray curve type (C = 0.296, P = 0.000), and the ration of presence of microcalcification (C = 0.246, P = 0.006). No significant difference were found in age, lesion margin, enhancement degree and background parenchyma enhancement of BC among different tumor subtypes. Luminal A group was mostly characterized with lesion size ≤ 2 cm (63%), and showed high ratio of heterogeneous enhancement (90.0%). Luminal B type was more featured by mass-appearance (74.6%), circular margin (40.9%), and plateau curve (45.8%). BC with HER-2 overexpression exhibited high proportion of non-mass lesions (66.7%). Triple-negative BC was more common with mass-type lesion (91.3%), oval shape (47.6%) and rim enhancement (66.7%). CONCLUSION: In summary, the imaging features of lesion size, morphology, enhancement patterns and perfusion change on CEM images in BC vary among different molecular subtypes., aiding in preliminary prediction and analysis of the molecular subtypes. CLINICAL TRIAL NUMBER: Not applicable.