Background Breast cancer is the leading cause of cancer-related mortality in women. Human epidermal growth factor receptor 2 (HER2) overexpression is seen in 20 out of 100 invasive breast cancers. Among HER2+ patients, two distinct hormone receptor (HR) subtypes can be defined: HR-positive (HR+) and HR-negative (HR−) each of which with unique therapeutic response and survival pattern. Contrast-enhanced spectral mammography (CESM) is an emerging novel imaging modality that offers diagnostic performance comparable to contrast-enhanced MRI. The purpose of this retrospective study was to describe the CESM features of HER2+ breast cancers according to hormone receptor status and to assess whether specific mammographic and CESM imaging features can differentiate between HER2+/HR+ and HER2+/HR− breast cancers potentially aiding treatment planning in HER2+ breast cancer patients. Results A total of 61 patients were included. Twenty-nine cases (47.5%) were HER2+/HR+ and 32 cases (52.5%) were HER2+/HR−. No statistically significant difference was found between mammographic imaging presentations and hormonal status. HR- were more likely to be multifocal (P 0.018), rounded or oval (P 0.008), circumscribed (P 0.004), and with associated non-mass enhancement (NME) (P < 0.001). HR+ cancers showed a tendency for irregular shape (P 0.008), spiculated outline (P 0.004), and heterogeneous (P 0.021) or ring (P 0.046) enhancement. Conclusions HER2+ tumors have different demographic, pathologic and imaging features according to the hormone receptor status. Because the two subtypes of HER2 breast cancer have different clinical outcomes, CESM imaging features can potentially enhance patient outcome by accelerating the diagnosis and treatment.
Background Neoadjuvant chemotherapy (NAC) is currently one of the most commonly utilized treatment options for patients with breast cancer. Evaluating residual disease following NAC is vital in post-chemotherapy treatment planning. Underestimation or overestimation of the residual disease may result in incomplete surgical resection or unnecessary aggressive surgical treatment which can compromise patient survival or result in unwanted morbidity. Contrast-enhanced spectral mammography (CESM) is a new imaging modality that can provide both morphological and anatomical characterization of neoplastic breast lesions when MRI is unavailable or contraindicated. The aim of this prospective observational study was to evaluate the value of CESM in assessing the extent of residual disease following NAC and predicting complete response (CR) with histopathology as the gold standard. Results A total of 142 patients were included in our study with invasive duct carcinoma the most prevalent histopathological type seen in 81.7% of cases. The average tumor reduction in size was 40.8% by CESM and 35.8% by histopathology. Comparison between maximum tumor diameter after NAC by CESM and histopathology revealed a high degree of correlation (R = 0.918, p < 0.01). In 45.1% of cases, CESM underestimated the residual tumor size by an average of 1.1 cm. Comparison between CESM and histopathology in predicting CR yielded CESM sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of 96.7%, 84.6%, 97.2%, and 100%, respectively. Conclusions CESM is a new effective imaging modality in assessing residual disease in breast cancer patients receiving NAC. Post-NAC CESM correlated well with residual tumor size by histopathology with a tendency for underestimation. Careful assessment of CESM images should be made to accurately measure the exact tumor size to avoid overestimation or underestimation potentially increasing the extent of the operation. Proper assessment of the true extent of residual disease can help the surgeon to select the optimal surgical technique ensuring radical treatment of the disease improving patient survival and reducing morbidity.
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