Augmenting breast cancer diagnosis: Incorporating MRI for the assessment of major molecular subtypes
Authors: Meghavath Meghana , Gorantla Rajani , Danaboyina Ankamma Rao 
Published: October 2023

Objectives:
Breast cancer (BC) is one of the commonly encountered cancer in women around the world. It is a diverse medical disorder with multiple molecular subtypes that respond differently to therapy and have different prognoses. Subjects with the same stage of cancer and identical histological findings, on the other hand, can have disparities in clinical features and prognosis. Luminal A, Luminal B, Human epidermal growth factor receptor 2 (HER2) enriched, and triple-negative molecular subtypes were identified using novel technologies in expression analysis with DNA microarray. The precise identification of these subtypes is crucial for tailoring appropriate treatment strategies and improving patient outcomes. Dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) is an excellent imaging technique for determining the extent of disease in BC patients prior to surgery. DECMRI with gadolinium-based contrasts is now the most sensitive identification tool for diagnosis, and it can be used in conjunction with mammography and ultrasound (USG). It aids in the detection of lesions that are not visible using other approaches.

Material and Methods:
Cross-sectional, observational study done over a period of 1 year.
Sample size: 50

Inclusion criteria:

Patients with morphological features of Breast Imaging Reporting and Data System (BI-RADS) 4b,4c,5 on USG or mammogram.
Patients with malignancy confirmed through biopsy - BI-RADS 6.
Patients aged above 18 years.
Patients who provided informed consent to participate in the study.

Exclusion criteria:

Pregnant and lactating women.
Patients with pacemakers, prosthetic heart valves, cochlear implants, or any metallic implants.
Patients having a history of claustrophobia.
Patients with prior surgery in the breast, hormonal therapy, radiation, or chemotherapy.
Patients with previous allergic or anaphylactoid reactions to a gadolinium-based contrast.
Patients with altered renal function test and estimated glomerular filtration rate <30 mL/min/1.73 mm2.

Results:
There was a substantial relationship between shape and molecular subtype. The majority of the luminal type of cancers was irregular, whereas the basal type was round. There was no link found between margin and molecular subtypes. Noncircumscribed margins, on the other hand, were more common in luminal subtypes. Internal enhancement and molecular subtypes were found to be significantly related. Rim enhancement was more prevalent in the basal subtype. According to ANOVA analysis, there was a significant relationship between volume and molecular subtypes. At the time of presentation, Luminal B tumors had a significant tumor volume.

Conclusion:
In conclusion, MRI plays a pivotal role in the evaluation of molecular subtypes of breast cancer, providing valuable information for personalized treatment decisions.
Advancements in MRI technology and radiogenomics hold great promise for enhancing subtype-specific characterization and improving patient outcomes.