Abstract
PurposeThe mainstay modality of breast cancer screening in China is the hospital-based opportunistic screening among asymptomatic self-referred women. There is little data about the ultrasound (US) detected non-palpable breast cancer (NPBC) in Chinese population.MethodsWe analyzed 699 consecutive NPBC from 1.8-2.3 million asymptomatic women from 2001 to 2014, including 572 US-detected NPBC from 3,786 US-positive women and 127 mammography (MG) detected NPBC from 788 MG-positive women. The clinicopathological features, disease-free survival (DFS) and overall survival (OS) were compared between the US- and MG-detected NPBC. Prognostic factors of NPBC were identified.ResultsCompared to MG, US could detect more invasive NPBC (83.6% vs 54.3%, p<0.001), lymph node positive NPBC (19.1% vs 10.2%, p=0.018), lower grade (24.8% vs 16.5%, p<0.001), multifocal (19.2% vs 6.3%, p<0.001), PR positive (71.4% vs 66.9%, p=0.041), Her2 negative (74.3% vs 54.3%, p<0.001), Ki67 high (defined as >14%, 46.3% vs 37.0%, p=0.031) cancers and more NPBC who received chemotherapy (40.7% vs 21.3%, p<0.001). There was no significant difference in 10-year DFS and OS between US-detected vs MG-detected NPBC, DCIS and invasive NPBC. For all NPBC and the US-detected NPBC, the common DFS-predictors included pT, pN, p53 and bilateral cancers.ConclusionUS could detect more invasive, node-positive, multifocal NPBC in hospital-based asymptomatic Chinese female, who could achieve comparable 10-year DFS and OS as MG-detected NPBC. US would not delay early detection of NPBC with improved cost-effectiveness, thus could serve as the feasible initial imaging modality in hospital-based opportunistic screening among Chinese women.
Highlights
Breast cancer is the most common cancer in Chinese women, and the leading cause of cancer death in women younger than 45 years [1, 2]
There was no significant difference in 10-year disease-free survival (DFS) and overall survival (OS) between US-detected vs MG-detected non-palpable breast cancer (NPBC), ductal carcinoma in situ (DCIS) and invasive NPBC
A total of 4,574 patients with positive screening imaging test underwent biopsies, including 3,786 US-guided biopsies and 788 MG-guided biopsies as described in METHOD. 729 NPBC were diagnosed with 588 US-detected NPBC and 141 MG-detected NPBC, the positive predictive value (PPV) of US-guided biopsy was 15.5% and the PPV of MG-guided biopsy was 17.9%
Summary
Breast cancer is the most common cancer in Chinese women, and the leading cause of cancer death in women younger than 45 years [1, 2]. The current mainstay modality of breast cancer early detection in China is the hospital-based opportunistic screening among asymptomatic self-referred women. Milestone studies showed that ultrasound (US) was a useful supplementary imaging tool of MG for women with dense breast or elevated risk [8,9,10,11,12,13,14], but an effective primary screening test for breast cancer both in the western world and in China [7, 15,16,17,18]. There is little data about the specific features and prognosis of the US-detected non-palpable breast cancer (NPBC) in hospital-based Chinese population. We performed this study to compare the clinicopathological characteristics and the long-term survival of US-detected and MG-detected NPBC in Chinese women
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