Tumor and Tissue Features in Mammography and MRI – Associations with Breast-Cancer Characteristics and Prognosis
Sturesdotter, Li LU
(2026)
In Lund University, Faculty of Medicine Doctoral Dissertation Series
- Abstract
- Introduction
Breast cancer is a heterogeneous disease in which imaging plays a central role. Beyond identifying malignancy, imaging provides information about the mammographic tumor appearance, breast density, and characteristics of the surrounding adipose tissue, which may reflect underlying tumor biology and relate to the prognosis. The aim of this thesis was to explore how features from mammography and MRI relate to characteristics and outcomes of breast cancer.
Methods
Papers I–III were observational studies involving women with invasive breast cancer in the Malmö Diet and Cancer Study cohort. Mammographic tumor appearance, breast density, and the mode of detection were linked to histopathology, surrogate molecular... (More) - Introduction
Breast cancer is a heterogeneous disease in which imaging plays a central role. Beyond identifying malignancy, imaging provides information about the mammographic tumor appearance, breast density, and characteristics of the surrounding adipose tissue, which may reflect underlying tumor biology and relate to the prognosis. The aim of this thesis was to explore how features from mammography and MRI relate to characteristics and outcomes of breast cancer.
Methods
Papers I–III were observational studies involving women with invasive breast cancer in the Malmö Diet and Cancer Study cohort. Mammographic tumor appearance, breast density, and the mode of detection were linked to histopathology, surrogate molecular subtypes, and long-term breast-cancer-specific survival using regression models and Cox analyses. Paper IV evaluates a chemical-shiftencoded MRI technique to quantify fatty acid composition in breast adipose tissue. A total of 68 women underwent a dedicated multi-echo MRI sequence, and the results from the MRI examination were compared to breast density, menopausal status, tumor proximity, and gas chromatography.
Results
Spiculated mammographic tumor appearance was strongly associated with favorable cancer characteristics, including hormone-receptor positivity, lower grade, lower Ki67 expression, and the luminal A-like subtype. Distinct masses were more often triple-negative breast cancer, whereas tumors
with calcifications were more frequently HER2-positive. However, neither mammographic tumor appearance nor breast density was significantly associated with breast-cancer-specific survival. A novel metric quantifying the degree of spiculation, the Spic Mass Ratio, correlated with age and breast density but did not predict axillary-lymph-node involvement or survival. MRI-derived adipose content was lower in dense breasts and in premenopausal women. In women with unilateral cancer, the cancer-affected breast contained less adipose tissue than the contralateral breast. The proportion of saturated fatty acids was highest adjacent to cancer, although this finding was not statistically significant, potentially due to lack of power.
Conclusion
Mammographic features at the time of breast cancer diagnosis reflect tumor biology to some extent but cannot independently predict breast-cancer survival. Chemical-shift-encoded MRI accurately depicts adipose tissue and shows potential for characterizing fatty acid composition but warrants further study to determine its potential clinical application. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/8734fd08-a6fc-4c00-8d91-4552e1c5645f
- author
- Sturesdotter, Li
LU
- supervisor
- opponent
-
- MD, Associate Professor Lindqvist, Ebba, Karolinska Institutet, Stockholm
- organization
- publishing date
- 2026
- type
- Thesis
- publication status
- published
- subject
- keywords
- Breast imaging, Breast cancer, Mammography, MRI, CSE-MRI, Tumor features, Breast density, Mammary adipose tissue, Fatty acid composition
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- issue
- 2026:39
- pages
- 95 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Rum 2005/2007, Inga Marie Nilssons gata 47, Skånes Universitetssjukhus i Malmö
- defense date
- 2026-03-27 09:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-837-5
- language
- English
- LU publication?
- yes
- id
- 8734fd08-a6fc-4c00-8d91-4552e1c5645f
- date added to LUP
- 2026-02-26 20:51:08
- date last changed
- 2026-03-11 13:47:47
@phdthesis{8734fd08-a6fc-4c00-8d91-4552e1c5645f,
abstract = {{Introduction<br/>Breast cancer is a heterogeneous disease in which imaging plays a central role. Beyond identifying malignancy, imaging provides information about the mammographic tumor appearance, breast density, and characteristics of the surrounding adipose tissue, which may reflect underlying tumor biology and relate to the prognosis. The aim of this thesis was to explore how features from mammography and MRI relate to characteristics and outcomes of breast cancer.<br/><br/>Methods<br/>Papers I–III were observational studies involving women with invasive breast cancer in the Malmö Diet and Cancer Study cohort. Mammographic tumor appearance, breast density, and the mode of detection were linked to histopathology, surrogate molecular subtypes, and long-term breast-cancer-specific survival using regression models and Cox analyses. Paper IV evaluates a chemical-shiftencoded MRI technique to quantify fatty acid composition in breast adipose tissue. A total of 68 women underwent a dedicated multi-echo MRI sequence, and the results from the MRI examination were compared to breast density, menopausal status, tumor proximity, and gas chromatography.<br/><br/>Results<br/>Spiculated mammographic tumor appearance was strongly associated with favorable cancer characteristics, including hormone-receptor positivity, lower grade, lower Ki67 expression, and the luminal A-like subtype. Distinct masses were more often triple-negative breast cancer, whereas tumors<br/>with calcifications were more frequently HER2-positive. However, neither mammographic tumor appearance nor breast density was significantly associated with breast-cancer-specific survival. A novel metric quantifying the degree of spiculation, the Spic Mass Ratio, correlated with age and breast density but did not predict axillary-lymph-node involvement or survival. MRI-derived adipose content was lower in dense breasts and in premenopausal women. In women with unilateral cancer, the cancer-affected breast contained less adipose tissue than the contralateral breast. The proportion of saturated fatty acids was highest adjacent to cancer, although this finding was not statistically significant, potentially due to lack of power.<br/><br/>Conclusion<br/>Mammographic features at the time of breast cancer diagnosis reflect tumor biology to some extent but cannot independently predict breast-cancer survival. Chemical-shift-encoded MRI accurately depicts adipose tissue and shows potential for characterizing fatty acid composition but warrants further study to determine its potential clinical application.}},
author = {{Sturesdotter, Li}},
isbn = {{978-91-8021-837-5}},
issn = {{1652-8220}},
keywords = {{Breast imaging; Breast cancer; Mammography; MRI; CSE-MRI; Tumor features; Breast density; Mammary adipose tissue; Fatty acid composition}},
language = {{eng}},
number = {{2026:39}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Tumor and Tissue Features in Mammography and MRI – Associations with Breast-Cancer Characteristics and Prognosis}},
url = {{https://lup.lub.lu.se/search/files/243408328/Li_Sturesdotter_-_WEBB.pdf}},
year = {{2026}},
}