title: The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients.
abstract: Mammography and ultrasound are the gold standard imaging techniques for preoperative assessment and for monitoring the efficacy of neoadjuvant chemotherapy in breast cancer. Maximum accuracy in predicting pathological tumor size non-invasively is critical for individualized therapy and surgical planning. We therefore aimed to assess the accuracy of tumor size measurement by ultrasound and mammography in a multicentered health services research study.
  
  
  
  We retrospectively analyzed data from 6543 patients with unifocal, unilateral primary breast cancer. The maximum tumor diameter was measured by ultrasound and/or mammographic imaging. All measurements were compared to final tumor diameter determined by postoperative histopathological examination. We compared the precision of each imaging method across different patient subgroups as well as the method-specific accuracy in each patient subgroup.
  
  
  
  Overall, the correlation with histology was 0.61 for mammography and 0.60 for ultrasound. Both correlations were higher in pT2 cancers than in pT1 and pT3. Ultrasound as well as mammography revealed a significantly higher correlation with histology in invasive ductal compared to lobular cancers (p < 0.01). For invasive lobular cancers, the mammography showed better correlation with histology than ultrasound (p = 0.01), whereas there was no such advantage for invasive ductal cancers. Ultrasound was significantly superior for HR negative cancers (p < 0.001). HER2/neu positive cancers were also more precisely assessed by ultrasound (p < 0.001). The size of HER2/neu negative cancers could be more accurately predicted by mammography (p < 0.001).
  
  
  
  This multicentered health services research approach demonstrates that predicting tumor size by mammography and ultrasound provides accurate results. Biological tumor features do, however, affect the diagnostic precision.
authors.affiliation: Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany. stein_r@ukw.de.
authors.forename: Roland Gregor
authors.initials: RG
authors.lastname: Stein
authors.affiliation: Insititute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz University Hospital, Mainz, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wollschläger
authors.affiliation: Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kreienberg
authors.affiliation: Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.affiliation: e-Science, Bremen University, Bremen, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Wischnewsky
authors.affiliation: Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Diessner
authors.affiliation: Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Stüber
authors.affiliation: Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
authors.forename: Catharina
authors.initials: C
authors.lastname: Bartmann
authors.affiliation: Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Krockenberger
authors.affiliation: Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Wischhusen
authors.affiliation: Department of Obstetrics and Gynecology, Würzburg University Hospital, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Wöckel
authors.affiliation: Insititute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz University Hospital, Mainz, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Blettner
authors.affiliation: Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Schwentner
mesh_terms: D000368:Aged; D001940:Breast / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: Breast cancer; Histopathology; Mammography; Tumor size; Ultrasound