ORIGINAL RESEARCH article
Front. Oncol.
Sec. Breast Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1555743
Risk stratification by ultrasound and mammography for screen-detected non-palpable breast cancer in Chinese women
Provisionally accepted
- Peking Union Medical College Hospital (CAMS), Beijing, China
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Background: Mammography (MG) and ultrasound (US) are currently the 'real-world' initial imaging tests for breast cancer in China. Previously, we demonstrated that US and MG detected non-palpable breast cancer (NPBC) had similar survival. This study was performed to validate the hypothesis whether MG+/US-NPBC could be taken as ultra-low risk cancer. Method: From 2015-2018, 3,113 consecutive patients received biopsy with initial positive screening. Among them, 2,591 US positive patients underwent US-guided biopsy. Meanwhile, 371 MG+/US-patients underwent MG-guided biopsy. Clinical characteristics, treatment and 5-year disease free survival (DFS) and overall survival (OS) were analyzed. Prognostic factors of NPBC were identified. Results: We identified 419 cases of US+/MG-, 225 cases of US+/MG+, and 118 cases of US-/MG+ breast cancers, yielding positive predictive values (PPVs) of 21.6%, 34.7%, and 22.6%, respectively. Notably, among NPBC with US-/MG+ features, a significantly higher proportion exhibited DCIS (50.8%, P<0.001), multifocality (18.5%, P=0.003), underwent breast-conserving surgeries (66.1%, P<0.001), and did not receive chemotherapy or radiotherapy (64.4% & 66.9%, P<0.001 & P=0.032). MG+/US-patients demonstrated improved DFS compared to US+/AnyMG (P=0.035), with no significant difference in OS (P=0.48). Univariate and multivariate Cox regression analysis identified age, TNM stage, lymphovascular invasion (LVI), and estrogen receptor (ER) status as significant DFS predictors(P<0.05), with ER status alone being significant for OS (P=0.002). Conclusion: MG⁺/US⁻ NPBC was associated with a favorable prognosis in this study, potentially 2 representing an "ultra-low-risk" subtype of breast cancer that warrants further investigation. Hence US had the potential of stratifying the screen-detected NPBC into regular low risk (US+/MG+ and US+/MG-) and ultra-low risk (MG+/US-).
Keywords: Chinese women, Non-palpable breast cancer, ultrasound, Mammography, prognosis
Received: 05 Jan 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Xu, Yao, Lin, Mao, Zhang, Shen, Pan, Zhou and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qiang Sun, sunqiangpumch@yeah.net
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