title: Do mammographic tumor features in breast cancer relate to breast density and invasiveness, tumor size, and axillary lymph node involvement?
abstract: BACKGROUND
  Breast density and mammographic tumor features of breast cancer may carry prognostic information. The potential benefit of using the combined information obtained from breast density, mammographic tumor features, and pathological tumor characteristics has not been extensively studied.
  
  
  OBJECTIVE
  To investigate how mammographic tumor features relate to breast density and pathological tumor characteristics.
  
  
  METHODS
  This retrospective study was carried out within the Malmö Diet and Cancer Study: a population-based cohort study recruiting 17,035 women during 1991-1996. A total of 826 incident breast cancers were identified during follow-up. Mammography images were collected and analyzed according to breast density and tumor features at diagnosis. Pathological data were retrieved from medical reports. Mammographic tumor features in relation to invasiveness, tumor size, and axillary lymph node involvement were analyzed using logistic regression yielding odds ratios (OR) with 95% confidence intervals (CI) and adjusted for age at diagnosis, mode of detection, and breast density.
  
  
  RESULTS
  Tumors presenting as an ill-defined mass or calcifications were more common in dense breasts than tumors presenting as a distinct mass or with spiculated appearance. Invasive cancer was more common in tumors with spiculated appearance than tumors presenting as a distinct mass (adjusted OR, 5.68 [1.81-17.84]). Among invasive tumors, an ill-defined mass was more often large (>20 mm) compared with a distinct mass, (adjusted OR, 3.16 [1.80-5.55]).
  
  
  CONCLUSIONS
  Tumors presenting as an ill-defined mass or calcifications were more common in dense breasts. Spiculated appearance was related to invasiveness, and ill-defined mass to larger tumor size, regardless of mode of detection and breast density. The potential role of mammographic tumor features in clinical decision-making warrants further investigation.
authors.affiliation: Diagnostic Radiology, Lund University, Diagnostic Center for Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden Hanna.Sartor@med.lu.se.
authors.forename: Hanna
authors.initials: H
authors.lastname: Sartor
authors.affiliation: Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden Department of Oncology, Skåne University Hospital, Lund, Sweden.
authors.forename: Signe
authors.initials: S
authors.lastname: Borgquist
authors.affiliation: Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden Regional Cancer Center South, Lund, Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Hartman
authors.affiliation: Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Olsson
authors.affiliation: Diagnostic Radiology, Lund University, Diagnostic Center for Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden.
authors.forename: Faith
authors.initials: F
authors.lastname: Jawdat
authors.affiliation: Diagnostic Radiology, Lund University, Diagnostic Center for Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zackrisson
mesh_terms: D000368:Aged; D001365:Axilla; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016017:Odds Ratio; D012189:Retrospective Studies; D013548:Sweden; D047368:Tumor Burden
keywords: Breast; adults; epidemiology; mammography; neoplasms – primary; pathology