title: Is there different correlation with prognostic factors between "non-mass" and "mass" type invasive ductal breast cancers?
abstract: OBJECTIVE
  To investigate the association between non-mass type breast cancer and common clinical-pathological prognostic factors, compared with mass type breast cancer.
  
  
  METHODS
  After institutional review board approval, retrospective blind review of contrast-enhanced breast MRI was carried out for 88 histologically proven breast invasive ductal carcinoma (IDC) patients, presenting from January 2008 to December 2011. Two radiologists assessed the images of each lesion for the morphologic enhancement type [mass enhancement or non-mass-like enhancement (NMLE)] and the distribution/internal enhancement of NMLE. Two pathologists evaluated the histological grade of IDC, presence or absence of ductal carcinoma in situ (DCIS), lymph node status, presence or absence of vascular invasion, and expression status of estrogen receptor (ER)/progesterone receptor (PR)/HER-2/p53 tumor suppressor gene (p53)/Ki-67. Inter-observer agreement was assessed with kappa test. Chi-square test and Spearman rank correlation were performed to explore the associations of morphologic enhancement type with the age, lesion size and the above pathological prognostic factors
  
  
  RESULTS
  Inter-observer agreement was excellent, with kappa>0.75. Morphologic enhancement type was significantly correlated with age (P=0.02), with NMLE more commonly seen in women less than 50 y/o. The size of NMLE was larger than that of mass and, with the increase of lesion size, proportion of NMLE among the cases increased (P=0.001). NMLE was also significantly correlated with low histologic grade of IDC (P=0.003) and presence of DCIS (P<0.001). There was no significant correlation between morphologic enhancement type and lymph node status, vascular invasion, ER/PR/HER-2/p53/Ki-67 status. The histological grade was higher in clumped enhancement than non-clumped (P=0.011). There was no correlation between enhancement distribution and prognostic factors
  
  
  CONCLUSIONS
  Non-mass type breast cancer may not necessarily have worse prognosis than the mass type, due to lower histological grade and closely related to DCIS component, although it may has larger tumor size. Clumped enhancement may have worse prognosis than non-clumped enhancement.
authors.affiliation: Radiology Department, Beijing Hospital, Peking University, The Ministry of Health, Dahua Road 1#, East District, Beijing 100730, China. jiang_belinder@sina.com
authors.forename: Lei
authors.initials: L
authors.lastname: Jiang
authors.forename: Yiming
authors.initials: Y
authors.lastname: Zhou
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wang
authors.forename: Xu
authors.initials: X
authors.lastname: Lu
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhou
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015588:Observer Variation; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013223:Statistics as Topic
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Breast cancer; Invasive ductal carcinoma; MR imaging; Mass; Non-mass-like enhancement; Prognosis