The Pre-Operative Imaging Risk Factors for Lymphovascular Invasion in Breast Cancer as Determined by Mammography and Ultrasound Findings of Primary Breast Masses

Abstract

Objective: To determine pre-operative mammographic and ultrasound features predictive of lymphovascular invasion in patients with breast cancer presenting to a tertiary care center in Pakistan.

Methodology: This retrospective descriptive study was conducted at SIUT Breast Oncology OPD and Radiology department. The data were retrieved from the archival records of the Hospital covering the duration from 2017 to 2021. Medical data record of the patients with histopathologically proven breast cancer whose pre-treatment mammograms, ultrasounds and histopathology reports were available, patients who have undergone upfront mastectomy or breast-conserving surgery and LVI status confirmed by immunohistochemistry were incorporated. Imaging features were assessed for ultrasound, and mammography. LVI status was assessed on histopathology and correlated with imaging findings using univariate and multivariate logistic regression.

Results: The mean age of 201 patients enrolled in the study was 48.04 ± 11.65 years. The LVI was observed in 131 (65.2%) patients. According to univariate analysis, non-circumscribed ultrasound margins (OR 22.08), posterior shadowing (OR 3.29), irregular shape of mass by ultrasound (OR 3.03), raised size of mass on ultrasound (OR 1.18/cm), and the dense breast tissue (OR 2.27) were significantly linked to LVI (p<0.05). Additionally, on multivariable analysis, the breast density (adjusted OR 2.3), posterior shadowing (adjusted OR 3.17), and ultrasound mass size (adjusted OR 1.23/cm remained significant independent predictors for LVI, (p<0.05).

Conclusion: Mammographic and ultrasound features, specifically irregular margins, mass shape, posterior shadowing, and breast density, observed as helpful preoperative predictors of LVI. Due few significant limitations further larger prospective studies are needed to validate this approach before routine clinical practice.