Mammographic Density and Prediction of Nodal Status in Breast Cancer
                    Patients

C. C. Hack; L. Häberle; K. Geisler; R. Schulz-Wendtland; A. Hartmann; P. A. Fasching; M. Uder; D. L. Wachter; S. M. Jud; C. R. Loehberg; M. P. Lux; C. Rauh; M. W. Beckmann; K. Heusinger

doi:10.1055/s-0032-1328291

Geburtshilfe und Frauenheilkunde, Table of Contents

Geburtshilfe Frauenheilkd 2013; 73(2): 136-141
DOI: 10.1055/s-0032-1328291

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Mammographic Density and Prediction of Nodal Status in Breast Cancer Patients

Einfluss der mammografischen Dichte auf die Prädiktion des Nodalstatus bei Mammakarzinompatientinnen

C. C. Hack

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

L. Häberle

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

K. Geisler

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

R. Schulz-Wendtland

²Institut für gynäkologische Radiologie, Universitätsklinikum Erlangen, Erlangen

,

A. Hartmann

³Institute of Pathology, University Hospital Erlangen, Erlangen

,

P. A. Fasching

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

M. Uder

²Institut für gynäkologische Radiologie, Universitätsklinikum Erlangen, Erlangen

,

D. L. Wachter

³Institute of Pathology, University Hospital Erlangen, Erlangen

,

S. M. Jud

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

C. R. Loehberg

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

M. P. Lux

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

C. Rauh

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

M. W. Beckmann

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

,

K. Heusinger

¹Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen

› Author Affiliations

Abstract

Aim: Nodal status remains one of the most important prognostic factors in breast cancer. The cellular and molecular reasons for the spread of tumor cells to the lymph nodes are not well understood and there are only few predictors in addition to tumor size and multifocality that give an insight into additional mechanisms of lymphatic spread. Aim of our study was therefore to investigate whether breast characteristics such as mammographic density (MD) add to the predictive value of the presence of lymph node metastases in patients with primary breast cancer. Methods: In this retrospective study we analyzed primary, metastasis-free breast cancer patients from one breast center for whom data on MD and staging information were available. A total of 1831 patients were included into this study. MD was assessed as percentage MD (PMD) using a semiautomated method and two readers for every patient. Multiple logistic regression analyses with nodal status as outcome were used to investigate the predictive value of PMD in addition to age, tumor size, Ki-67, estrogen receptor (ER), progesterone receptor (PR), grading, histology, and multi-focality. Results: Multifocality, tumor size, Ki-67 and grading were relevant predictors for nodal status. Adding PMD to a prediction model which included these factors did not significantly improve the prediction of nodal status (p = 0.24, likelihood ratio test). Conclusion: Nodal status could be predicted quite well with the factors multifocality, tumor size, Ki-67 and grading. PMD does not seem to play a role in the lymphatic spread of tumor cells. It could be concluded that the amount of extracellular matrix and stromal cell content of the breast which is reflected by MD does not influence the probability of malignant breast cells spreading from the primary tumor to the lymph nodes.

Zusammenfassung

Ziel: Der Nodalstatus ist nach wie vor einer der wichtigsten Prognosefaktoren für Patientinnen mit Mammakarzinom. Die zellulären und molekularen Gründe hierfür sind nicht gut verstanden, und es gibt nur wenige Prädiktoren außer Tumorgröße und Multifokalität, die einen zusätzlichen Einblick in die Mechanismen der lymphatischen Metastasierung geben. Ziel unserer Studie war es daher zu untersuchen, ob die mammografische Dichte (MD) als Korrelat der Stroma- und Extrazellularmatrixmenge mit dem Auftreten von Lymphknotenmetastasen korreliert. Methoden: In dieser retrospektiven Studie sind Patientinnen mit pimärem, metastasenfreien Mammakarzinom eingeschlossen wurden, die in einer Institution behandelt wurden. Von allen Patientinnen musste die MD bekannt sein, genauso wie die Staging-Informationen. Die MD wurde semiautomatisiert als prozentuale MD (PMD) von 2 unabhängigen Gutachtern beurteilt. Logistische Regressionsanalysen mit dem Nodalstatus als Zielvariable wurden durchgeführt, um den zusätzlichen prädiktiven Wert von PMD zusätzlich zu Alter, Tumorgröße, Ki-67, Östrogenrezeptorstatus (ER) und Progesteronrezeptorstatus (PR), Grading, Tumortyp und Multifokalität zu bestimmen. Ergebnisse: Multifokalität, Tumorgröße, Ki-67 und Grading waren relevante Prädiktoren des Nodalstatus. Die Hinzunahme von PMD zu diesen Faktoren konnte die Vorhersage des Nodalstatus nicht signifikant verbessern (p = 0,24, Likelihood-Ratio-Test). Schlussfolgerung: Der Nodalstatus konnte relativ gut durch die Parameter Multifokalität, Tumorgröße, Ki-67 und Grading vorhergesagt werden. PMD scheint keine Rolle zu spielen bei der Lymphknotenmetastasierung aus dem Primärtumor. Somit scheint die Menge an Extrazellularmatrix und Stroma, welche das Korrelat der MD ist, keinen Einfluss auf die Wahrscheinlichkeit zu haben, mit der Brustkrebszellen lymphatisch metastasieren.

Key words

nodal status - estrogen receptor - progesterone receptor - Ki-67 - breast cancer - mammographic density

Schlüsselwörter

Nodalstatus - Östrogenrezeptor - Progesteronrezeptor - Ki-67 - Mammakarzinom - mammografische Dichte

Full Text

References

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