Relationships between HER2 protein expression and imaging features in HER2 positive breast cancer patients

doi:10.3760/cma.j.cn371439-20221214-00101

Abstract

Abstract:

Objective To investigate the relationships between the expression level of human epidermal growth factor receptor 2 （HER2） in HER2-positive breast cancer and the characteristics of ultrasound imaging and mammography. Methods The imaging data of 486 patients with HER2-positive breast cancer treated in the Harbin Medical University Cancer Hospital from January 2014 to December 2021 were retrospectively collected. The relationships between the expression level of HER2 and the imaging features of breast ultrasound and mammography were analyzed. Results 49.38% （240/486） of HER2-positive breast cancer patients were HER2 2+， and 50.62% （246/486） of HER2-positive breast cancer patients were HER2 3+. The age of HER2 2+ patients [（52.88±1.16） years] was older than the age of HER2 3+ patients [（49.59±1.00） years]， and there was a statistically significant difference （t=18.07， P<0.001）. There was a statistically significant difference of menstrual status between HER2 2+ patients and HER2 3+ patients （χ²=4.42， P=0.036）. There were statistically significant differences in the ultrasonography showed burr sign （χ²=8.37， P=0.010）， posterior echo （χ²=9.68， P=0.017）， axillary lymph node enlargement （χ²=15.77， P<0.001） between HER2 2+ patients and HER2 3+ patients. There was a statistically significant difference in the mammography showed whether there were lumps between HER2 2+ patients and HER2 3+ patients （χ²=15.81， P<0.001）. Conclusion The expression level of HER2 in HER2-positive breast cancer patients is related to burr sign， posterior echo， and axillary lymph node enlargement shown by ultrasound， as well as lumps shown by mammography， which can provide certain information for clinical prediction of malignant degree of breast cancer， prognosis and individualized treatment plan.

Key words: Breast neoplasms, Receptor， erbB-2, Ultrasonography, Mammography

Feng Chengtian, Huang Furong, Cao Shiyu, Wang Jianyu, Nanding Abiyasi, Jiang Yongdong, Zhu Juanying. Relationships between HER2 protein expression and imaging features in HER2 positive breast cancer patients[J]. Journal of International Oncology, 2023, 50(9): 527-531.

Figures/Tables 3

References 22

[1]	Wu T, Li J, Wang D, et al. Identification of a correlation between the sonographic appearance and molecular subtype of invasive breast cancer: a review of 311 cases[J]. Clin Imaging, 2019, 53: 179-185. DOI: 10.1016/j.clinimag.2018.10.020.
[2]	高威, 邵均均, 朱敬蕊, 等. HER2蛋白表达对乳腺癌预后的影响[J]. 安徽预防医学杂志, 2019, 25(6): 484-486.
[3]	琚倩, 史加宁, 杨继鑫, 等. IHC与FISH对HER2阳性乳腺癌新辅助靶向治疗疗效的预测价值[J]. 中华肿瘤防治杂志, 2022, 29(2): 135-140. DOI: 10.16073/j.cnki.cjcpt.2022.02.08.
[4]	Giuliani S, Ciniselli CM, Leonardi E, et al. In a cohort of breast cancer screened patients the proportion of HER2 positive cases is lower than that earlier reported and pathological characteristics differ between HER2 3+ and HER2 2+/Her2 amplified cases[J]. Virchows Arch, 2016, 469(1): 45-50. DOI: 10.1007/s00428-016-1940-y.
[5]	Xu B, Shen J, Zhang L, et al. HER2 protein expression level is positively associated with the efficacy of neoadjuvant systemic therapy in HER2-positive breast cancer[J]. Pathol Res Pract, 2022, 234: 153900. DOI: 10.1016/j.prp.2022.153900.
[6]	Wojcinski S, Stefanidou N, Hillemanns P, et al. The biology of malignant breast tumors has an impact on the presentation in ultrasound: an analysis of 315 cases[J]. BMC Womens Health, 2013, 13: 47. DOI: 10.1186/1472-6874-13-47. pmid: 24252758
[7]	Mohanty SS. Correlation of expression of hormone and HER2 receptors with various clinico-pathological prognostic parameters and with each other in malignant breast lesion[J]. Ann Diagn Pathol, 2021, 50: 151659. DOI: 10.1016/j.anndiagpath.2020.151659.
[8]	周亮, 马亚楠. 乳腺癌超声毛刺征患者的相关免疫组合指标表达情况[J]. 中国当代医药, 2022, 29(31): 129-132. DOI: 10.3969/j.issn.1674-4721.2022.31.034.
[9]	Fukui K, Masumoto N, Shiroma N, et al. Novel tumor-infiltrating lymphocytes ultrasonography score based on ultrasonic tissue fin-dings predicts tumor-infiltrating lymphocytes in breast cancer[J]. Breast Cancer, 2019, 26(5): 573-580. DOI: 10.1007/s12282-019-00958-3. pmid: 30868399
[10]	Irshad A, Leddy R, Pisano E, et al. Assessing the role of ultrasound in predicting the biological behavior of breast cancer[J]. AJR Am J Roentgenol, 2013, 200(2): 284-290. DOI: 10.2214/AJR.12.8781.
[11]	Çelebi F, Pilancı KN, Ordu Ç, et al. The role of ultrasonographic findings to predict molecular subtype, histologic grade, and hormone receptor status of breast cancer[J]. Diagn Interv Radiol, 2015, 21(6): 448-453. DOI: 10.5152/dir.2015.14515. pmid: 26359880
[12]	Yuan C, Jin F, Guo X, et al. Correlation analysis of breast cancer DWI combined with DCE-MRI imaging features with molecular subtypes and prognostic factors[J]. J Med Syst, 2019, 43(4): 83. DOI: 10.1007/s10916-019-1197-5. pmid: 30810823
[13]	Hanby AM. Aspects of molecular phenotype and its correlations with breast cancer behaviour and taxonomy[J]. Br J Cancer, 2005, 92(4): 613-617. DOI: 10.1038/sj.bjc.6602421.
[14]	Ménard S, Balsari A, Tagliabue E, et al. Biology, prognosis and response to therapy of breast carcinomas according to HER2 score[J]. Ann Oncol, 2008, 19(10): 1706-1712. DOI: 10.1093/annonc/mdn369. pmid: 18544559
[15]	Upadhyaya VS, Lim GH, Chan EYK, et al. Evaluating the preo-perative breast cancer characteristics affecting the accuracy of axi-llary ultrasound staging[J]. Breast J, 2020, 26(2): 162-167. DOI: 10.1111/tbj.13635.
[16]	姚娟, 李白艳, 马华, 等. 乳腺X线钼靶表现与ER、PR和HER2表达的乳腺癌亚型的病理对照研究[J]. 新疆医科大学学报, 2017, 40(9): 1181-1186. DOI: 10.3969/j.issn.1009-5551.2017.09.015.
[17]	Rashmi S, Kamala S, Murthy SS, et al. Predicting the molecular subtype of breast cancer based on mammography and ultrasound findings[J]. Indian J Radiol Imaging, 2018, 28(3): 354-361. DOI: 10.4103/ijri.IJRI_78_18.
[18]	Park YJ, Youk JH, Son EJ, et al. Comparison of hormonal receptor and HER2 status between ultrasound-guided 14-gauge core needle biopsy and surgery in breast cancer patients[J]. Ultrasonography, 2014, 33(3): 206-215. DOI: 10.14366/usg.14014. pmid: 25038811
[19]	Zhou J, Tan H, Bai Y, et al. Evaluating the HER-2 status of breast cancer using mammography radiomics features[J]. Eur J Radiol, 2019, 121: 108718. DOI: 10.1016/j.ejrad.2019.108718.
[20]	Sonthineni C, Mohindra N, Agrawal V, et al. Correlation of digital mammography and digital breast tomosynthesis features of self-detected breast cancers with human epidermal growth factor receptor type 2/neu status[J]. South Asian J Cancer, 2019, 8(3): 140-144. DOI: 10.4103/sajc.sajc_300_18. pmid: 31489283
[21]	Song SE, Bae MS, Chang JM, et al. Mr and mammographic imaging features of HER2-positive breast cancers according to hormone receptor status: a retrospective comparative study[J]. Acta Radiol, 2017, 58(7): 792-799. DOI: 10.1177/0284185116673119. pmid: 27754920
[22]	Elias SG, Adams A, Wisner DJ, et al. Imaging features of HER2 overexpression in breast cancer: a systematic review and meta-analysis[J]. Cancer Epidemiol Biomarkers Prev, 2014, 23(8): 1464-1483. DOI: 10.1158/1055-9965.

临床特征	HER2 2+ （n=240）	HER2 3+ （n=246）	t/χ²值	P值
年龄（岁）	52.88±1.16	49.59±1.00	18.07	<0.001
月经状态
未绝经	103（42.92）	129（52.44）	4.42	0.036
绝经	137（57.08）	117（47.56）	4.42	0.036
家族史
有	8（3.33）	10（4.07）	0.18	0.669
无	232（96.67）	236（95.93）	0.18	0.669

超声影像学特征	HER2 2+ （n=240）	HER2 3+ （n=246）	t/χ²值	P值
肿瘤直径（mm）	25.18±1.45	24.94±1.32	0.06	0.809
纵横比
≤1	224（93.33）	224（91.05）
>1	8（3.33）	10（4.07）	0.95	0.622
不详	8（3.33）	12（4.88）
毛刺征
无	208（86.67）	232（94.31）
有	28（11.66）	13（5.28）	8.37	0.010
不详	4（1.67）	1（0.41）
内部回声
均匀	23（9.58）	17（6.91）
不均匀	213（88.75）	228（92.68）	2.98	0.212
不详	4（1.67）	1（0.41）
后方回声
无改变	213（88.75）	199（80.89）	9.68	0.017
衰减	18（7.50）	36（14.63）
增强	5（2.08）	10（4.07）
不详	4（1.67）	1（0.41）
微钙化
无	76（31.67）	82（33.33）
有	162（67.50）	163（66.26）	0.57	0.800
不详	2（0.83）	1（0.41）
腋窝淋巴结肿大
无	172（71.67）	134（54.47）
有	65（27.08）	109（44.31）	15.77	<0.001
不详	3（1.25）	3（1.22）

X线影像学特征	HER2 2+ （n=240）	HER2 3+ （n=246）	χ²值	P值
肿块
无	83（34.58）	46（18.70）
有	148（61.67）	190（77.24）	15.81	<0.001
不详	9（3.75）	10（4.06）
异常钙化
无	103（42.92）	83（33.74）
有	129（53.75）	152（61.79）	4.43	0.109
不详	8（3.33）	11（4.47）
腋窝淋巴结肿大
无	213（88.75）	201（81.71）
有	19（7.92）	32（13.01）	4.78	0.092
不详	8（3.33）	13（5.28）