Imaging Characteristics and Hormonal Receptor Correlations in Varieties of Breast Cancer
Authors: Hoti Adrian , Hoti Eda , Shpuza Aldo , Xhetani Xhesika , Gjonbrataj Endri , Muja Eva , Roshi Enver , Ikonomi Majlinda 
Published: March 2024

Background: While there is acknowledgment of the vital role of factors such as the status of histological grades and hormone receptor (HR) in shaping targeted treatment strategies for breast cancer (BC), comprehensive research that unifies the study of imaging features with the evaluation of HR characteristics and histopathological data is notably absent in Albania, creating a critical research gap that this study endeavors to fill. This study aimed to investigate the imaging characteristics observed in ultrasound and the possible correlations between expression levels of HRs in ductal and lobular types of BC to elucidate potential prognostic and therapeutic implications. Methods and Results: This descriptive study, conceived as a series of cases, leveraged a prospective approach to scrutinize the dynamics of the study population over four years (2019-2023) in the Mother Teresa University Hospital Center and a private oncology clinic in Tirana. The convenience sampling strategy enlisted 238 female patients (mean age 60.5±12.5 years) diagnosed with BC who had been tested for HRs and consented to participate. Diagnostic imaging was facilitated using a Chison US equipped with a 10 MH linear probe. The results were adjudged based on the BI-RADS tumor classification.HR markers were discerned through rigorous immunohistochemical analyses. Utilizing SPSS version 21.0, statistical analyses incorporated a variety of tests, including Spearman's rho to assess correlations between hormonal receptors and imaging morphological characteristics and ordinal logistic regression to evaluate the relationships between hormonal receptors and cancer grades.	Analyzing the localization of the tumor revealed that a slightly higher proportion had it on the left side, accounting for 52.9% compared to 47.1% on the right side. Regarding the BI-RADS classification observed through echographic examination, a vast majority were classified as BI-RADS 5 (92.8%), followed by a smaller percentage distributed amongst BI-RADS 4 (5.9%), BI-RADS 3 (0.84%), and BIRADS 6 (0.42%). Examining the cancer grades determined that 68.3% were at Grade 2, whereas Grades 1 and 3 were noticeably less common, standing at 1.7% and 30.2%, respectively. Estrogen receptor (ER) and progesterone receptor (PgR) sensitivity were high in most patients, exhibiting 77.7% and 70.6% positivity, respectively, alongside a notable presence of high Ki67 levels in 75.2% of the individuals. The investigation into HER2 status demonstrated that a significant number were negative (76.1%), as opposed to 17.6% being positive and 6.3% equivocal. Remarkably, 5.5% of the patients had a triple-negative status upon biopsy evaluation.The Spearman's rho correlations displayed a moderate positive correlation between ER and PgR (rho=0.563) and a weak negative correlation between ER and Ki67 (rho=-0.343) (P<0.05 in both cases). PgR and Ki67 show a weak negative correlation (rho=-0.353, P<0.05), suggesting a tendency for higher PgR values to correspond with lower Ki67 values. The ordinal logistic regression analysis identified a statistically significant negative relationship between the ER variable and the outcome variable, denoted by a coefficient of -2.137, P<0.05. Additionally, Ki67 showcased a positive relationship with the outcome, as indicated by a coefficient of 5.150, P<0.05. Conclusion: This study delineates the nuanced relationships between biomarkers such as ER, PgR, and Ki67 in different types of infiltrative cancers, pointing to a complex interplay that necessitates further exploration while also noting the independence of BI-RADS imagery in these correlations.