Triple-Negative Breast Cancers: Associations Between Imaging and Pathological Findings for Triple-Negative Tumors Compared With Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor-2-Negative Breast Cancers

Abstract

Purpose. Triple-negative (TN) breast cancers have high malignancy potential and are often characterized by early systemic relapse. Early detection is vital, but there are few comprehensive imaging reports. Here we describe mammography, ultrasound, and magnetic resonance imaging (MRI) findings of TN breast cancers, investigate the specific features of this subtype, and compare the characteristics of TN breast cancers with those of hormone receptor (HR)-positive/human epidermal growth factor receptor (HER)-2-negative breast cancers. Materials and Methods. From July 2009 to June 2011, mammography and ultrasound findings of 210 patients with pathologically confirmed TN (n ϭ 105) and HR-positive/HER-2-negative breast cancers (n ϭ 105) were retrospectively reviewed from our institutional database. Ultrasound vascularity was notified in 88 cases and elasticity scores were notified in 49 cases overall. Thirty-five patients underwent MRI (22 TN and 13 HR-positive/HER-2-negative). Mammograms, ultrasound, and MRI were reviewed according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon and classification. Results. TN breast cancers were more likely to show round, oval, or lobulated masses with indistinct margins on mammography than HR-positive/HER-2-negative breast cancers. On ultrasound, TN tumors were more likely than HR-positive/ HER-2-negative breast cancers to show circumscribed or microlobulated margins and no posterior acoustic features or posterior enhancement-positive. On MRI, TN cancers exhibited suspicious aspects more often than HR-positive/HER-2-negative cancers, often with rim enhancement-positiveHER-2 (84.6% of masses were classified BI-RADS 5). Conclusion. This study is the first to describe findings on mammography, ultrasound, and MRI for TN breast cancers with a matched HR-positive/HER-2-negative control group. Several distinctive morphological features of these aggressive tumors are identified that can be used for earlier diagnosis and treatment, and ultimately to improve outcomes. The Oncologist 2013;18:802-811 Implications for Practice: Our results suggest that there are correlations between underlying phenotypes and distinctive imaging features for estrogen receptor (ER)-negative/progesterone receptor (PR)-negative/human epidermal growth factor receptor (HER)-negative cancers and ER-positive/EP-positive/HER-negative cancers. The findings show that the triple negative (TN) phenotype has a few characteristic radiological findings: an oval or lobulated mass with circumscribed or microlobulated margins and

The value of dynamic contrast-enhanced MRI in differentiating triple-negative breast cancer from other subtypes

“…Other MRI features in which we found significant differences were mass with rim enhancement in postcontrast images and intratumoral bright signal intensity on T2-weighted images; this may be due to tumor necrosis compared to predominant homogenous internal enhancement in the other subtypes. Our results were consistent with many studies [1,12,10,[19][20][21][22] which affirmed that rim enhancement is the most beneficial MR characteristic for identifying TNBC and it is accompanied with more aggressive tumors [23].…”

“…Patients with TNBC are commonly youthful with BRCA gene mutation, and they have dense breasts which additionally lowers mammographic sensitivity and specificity. The speedy progression of the TNBC which is not coupled with architectural distortions makes early detection of the disease exceptionally hard [12].…”

The value of dynamic contrast-enhanced MRI in the diagnosis and management of triple-negative breast cancer

“…Although TNBC accounts for a fairly little minority of breast cancer cases, it is responsible for a quite large share of breast cancer deaths, due to the commonly aggressive clinical course and the lack of successful targeted therapies [7,12]. Triple-negative phenotype is characterized by distinct clinical, histopathological, and molecular characteristics, and is associated with the development of recurrence, distant metastases, and a poorer prognosis; therefore, better understanding of the imaging features of TN cancers, especially at MRI, provides an imaging biomarker with clinical implications.…”

“…Patients with TNBC are commonly youthful with BRCA gene mutation, and they have dense breasts which additionally lowers mammographic sensitivity and specificity. The speedy progression of the TNBC which is not coupled with architectural distortions makes early detection of the disease exceptionally hard [7].…”

Correlating mammographic and pathologic findings in clinical decision support using natural language processing and data mining methods

“…19 Several retrospective studies and meta-analyses have described the associations between specific tumor subtypes and mammographic features by using manual record entry. [20][21][22][23][24][25][26][27] The purpose of the current study was to investigate the usefulness of data mining and NLP in defining the set of mammographic features correlated with the molecular subtypes of breast cancer in women with BI-RADS category 5 mammogram reports.…”