Ultrasound features of non-circumscribed margin associates with favorable prognosis in breast cancer patients in China: a retrospective cohort study

Background: This study aimed to evaluate the associations between ultrasound features and the biological characteristics of breast cancer, and to explore their prognostic potential. Methods: A total of 601 breast cancer patients from two independent centers were retrospectively analyzed, and their ultrasound features were assessed. Pearson’s Chi-square test was used to examine associations between ultrasound features and tumor biological characteristics. Prognostic factors associated with survival were identified using log-rank analysis and Cox regression models. Results: Patients with non-circumscribed margins were significantly associated with invasive ductal carcinoma (p = 0.004), smaller tumor size (p = 0.024), and positive estrogen receptor (ER) and progesterone receptor (PR) expression (both p < 0.001). In contrast, circumscribed margins were predominantly observed in basal-like carcinoma (p < 0.001). Posterior shadowing was associated with N3 lymph node status (p = 0.002) and positive PR expression (p = 0.025), while microcalcifications correlated with higher histological grade (p = 0.015). Patients with non-circumscribed margins demonstrated significantly longer progression-free survival (PFS) (p < 0.001) and overall survival (OS) (p < 0.001). A nomogram incorporating these four variables was developed to predict 5-, 7- and 10-year survival. The C-index for the nomogram was 0.752 (95% Confidence Interval (CI) [0.690–0.815]) in internal validation and 0.772 (95% CI [0.705–0.840]) in external validation. The area under the curve (AUC) for 5-, 7- and 10-year PFS was 0.729 (95%CI [0.636–0.820]), 0.759 (95% CI [0.687–0.830]) and 0.775 (95% CI [0.707–0.842]) in the training set, and 0.774 (95% CI [0.700–0.852]), 0.757 (95% CI [0.691–0.824]),and 0.775 (95% CI [0.701–0.849]) in the validation set. Conclusions: The presence of a non-circumscribed margin on ultrasound is a favorable prognostic factor in breast cancer. The developed nomogram provides an effective tool for accurately predicting PFS in breast cancer patients.

Breast cancer; Ultrasonic characteristics; Prognosis; Oncology; Nomogram

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