Diagnostic utility of ultrasound features in identifying triple-negative breast cancer

Background: Ultrasound is commonly used to characterise clinically detected mass and mammographically suspicious lesions, determine the probability of malignancy and guide biopsy. Besides assessing the morphological features of the cancer, ultrasound may provide potentially useful information on the histological grade and receptor status of the cancer. Aim: This study aimed to evaluate the utility of ultrasound features of breast cancer in predicting the triple-negative receptor type of breast cancer. Materials and Methods: This prospective study was carried out at the Alluri Sitarama Raju Academy of Medical Sciences over 15 months, involving 77 consecutive patients. Sonographic features such as tumour shape, margins, echogenicity, orientation, vascularity, posterior acoustic features and architectural distortion of the surrounding tissues were studied. Immunohistochemistry findings of all breast cancer cases were obtained, and the association between receptor status (triple negative vs. non-triple negative) and tumour grade with sonographic features was assessed. Results: In association with triple-negative breast cancer (TNBC) receptor status, lobulated margins had 80% sensitivity and 77.2% specificity, posterior acoustic enhancement had 70% sensitivity and 78.9% specificity, high vascularity had 85% sensitivity and 77.2% specificity, absence of architectural distortion had 85% sensitivity and 43.9% specificity and high-grade tumours had 75% sensitivity and 80.7% specificity. In association with non-TNBC receptor status, spiculated margins had 38.6% sensitivity and 95% specificity, posterior acoustic shadowing had 33.3% sensitivity and 78.9% specificity, low vascularity had 43.9% sensitivity and 65% specificity, presence of architectural distortion had 43.9% sensitivity and 85% specificity and low-grade tumours had 80.7% sensitivity and 70% specificity. Sonographic characteristics such as posterior acoustic features, margins, vascularity, grade and architectural distortion that could distinguish between TNBC and non-TNBC receptor status were statistically significant ( P < 0.05). Parameters such as shape, echogenicity and orientation showed no significant difference. Conclusions: Using ultrasound characteristics, it is possible to predict receptor status, whether a particular malignant lesion is triple negative or non-triple negative and its grade.