Radiological features of triple-negative breast cancers (73 cases)

MRI features of breast cancer immunophenotypes with a focus on luminal estrogen receptor low positive invasive carcinomas

To compare the magnetic resonance imaging (MRI) features of different immunophenotypes of breast carcinoma of no special type (NST), with special attention to estrogen receptor (ER)-low-positive breast cancer. This retrospective, single-centre, Institutional Review Board (IRB)-approved study included 398 patients with invasive breast carcinoma. Breast carcinomas were classified as ER-low-positive when there was ER staining in 1-10% of tumour cells. Pretreatment MRI was reviewed to assess the tumour imaging features according to the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Of the 398 cases, 50 (12.6%) were luminal A, 191 (48.0%) were luminal B, 26 (6.5%) were luminal ER-low positive, 64 (16.1%) were HER2-overexpressing, and 67 (16.8%) were triple negative. Correlation analysis between MRI features and tumour immunophenotype showed statistically significant differences in mass shape, margins, internal enhancement and the delayed phase of the kinetic curve. An oval or round shape and rim enhancement were most frequently observed in triple-negative and luminal ER-low-positive tumours. Spiculated margins were most common in luminal A and luminal B tumours. A persistent kinetic curve was more frequent in luminal A tumours, while a washout curve was more common in the triple-negative, HER2-overexpressing and luminal ER-low-positive immunophenotypes. Multinomial regression analysis showed that luminal ER-low-positive tumours had similar results to triple-negative tumours for almost all variables. Luminal ER-low-positive tumours present with similar MRI findings to triple-negative tumours, which suggests that MRI can play a fundamental role in adequate radiopathological correlation and therapeutic planning in these patients.

Ductal carcinoma in situ within a fibroadenoma: A case report and review of literature

BACKGROUND

Fibroadenoma (FA) is the most common tumor found in young women, although it can occur in any age group. Ductal carcinoma in situ (DCIS) that is confined in a FA is rare; it is most frequently reported as an incidental finding.

CASE SUMMARY

We report a case of DCIS within a FA in a 46-year-old female without cancer-related personal and family histories. The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year. In the current control image study, we found suspicious microcalcification, as a new finding, within one of the nodules. Consequently, a core biopsy of the tumor, which appeared hypoechoic, oval, and circumscribed, was performed. The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion. The patient underwent breast-conserving surgery and received radiotherapy as well as endocrine therapy (tamoxifen).

CONCLUSION

We recommend a multidisciplinary approach for adequate treatment and follow-up.

Measurement of malignant spiculated mass lesions on mammogram: Do we include the length of the spicules?

AIM

The aim of this study is to determine if the core size or size with spicules has a better correlation with the final histologic size of spiculated mass lesions.

METHODS

A retrospective study of 48-month duration from January 2014 to December 2017 of biopsy-proven invasive ductal carcinoma presenting as spiculated mass lesions on mammogram was conducted.

RESULTS

There were 195 patients in the study. The mean of the core size was 16.6 mm; when spicules were included the mean size was 27.4mm and final histologic size 21.1 mm. Using unpaired Student 't' test difference in the means was statistically significant (p<0.0001). Pearson number (R) core size versus final histologic size was 0.535 (P < 0.001) and for size with spicules versus final histologic size was 0.495 (P < 0.001).

CONCLUSION

Our study demonstrated that the core size has a stronger positive correlation to final histologic size and should be used preoperatively in decision-making about surgery.

Calcifications in triple-negative breast cancer: Molecular features and treatment strategies

Despite the high prevalence of mammographic calcifications, our understanding remains limited regarding the clinical and molecular features of calcifications within triple-negative breast cancer (TNBC). To investigate the clinical relevance and biological basis of TNBC with calcifications of high suspicion for malignancy, we established a study cohort (N = 312) by integrating mammographic records with clinical data and genomic, transcriptomic, and metabolomic profiling. Despite similar clinicopathological features, patients with highly suspicious calcifications exhibited a worse overall survival than those without. In addition, TNBC with highly suspicious calcifications was characterized by a higher frequency of PIK3CA mutation, lower infiltration of immune cells, and increased abnormality of lipid metabolism. Overall, our study systematically revealed clinical and molecular heterogeneity between TNBC with or without calcifications of high suspicion for malignancy. These data might help to understand the clinical relevance and biological basis of mammographic calcifications.

Nanoindentation study of the viscoelastic properties of human triple negative breast cancer tissues: Implications for mechanical biomarkers

This paper presents the results of a combined experimental and theoretical study of the structure and viscoelastic properties of human non-tumorigenic mammary breast tissues and triple negative breast cancer (TNBC) tissues of different histological grades. A combination of immunofluorescence and confocal microscopy, and atomic force microscopy is used to study the actin cytoskeletal structures of non-tumorigenic and tumorigenic breast tissues (grade I to grade III). A combination of nanoindentation and statistical techniques is then used to measure viscoelastic properties of non-tumorigenic and human TNBC of different histological grades. A Standard Fluid Model/Anti-Zener Model II is also used to characterize the viscoelastic properties of the non-tumorigenic and tumorigenic TNBC tissues of different grades. The implications of the results are discussed for the potential application of nanoindentation and statistical deconvolution techniques to the development of mechanical biomarkers for TNBC detection/cancer diagnosis. STATEMENT OF SIGNIFICANCE: There is increasing interest in the development of mechanical biomarkers for cancer diagnosis. Here, we show that nanoindentation techniques can be used to characterize the viscoelastic properties of normal breast tissue and TNBC tissues of different histological grades. The Standard Fluid Model (Anti-Zener Model II) is used to classify the viscoelastic properties of breast tissues of different TNBC histological grades. Our results suggest that breast tissue and TNBC tissue viscoelastic properties can be used as mechanical biomarkers for the detection of TNBC at different stages.

Radiologic-pathologic correlation in breast cancer: do MRI biomarkers correlate with pathologic features and molecular subtypes?

Background

Breast cancer (BC) includes different pathological and molecular subtypes. This study aimed to investigate whether multiparametric magnetic resonance imaging (mpMRI) could reliably predict the molecular status of BC, comparing mpMRI features with pathological and immunohistochemical results.

Methods

This retrospective study included 156 patients with an ultrasound-guided biopsy-proven BC, who underwent breast mpMRI (including diffusion-weighted imaging) on a 3-T scanner from 2017 to 2020. Histopathological analyses were performed on the surgical specimens. Kolmogorov–Smirnov Z, χ², and univariate and multivariate logistic regression analyses were performed.

Results

Fifteen patients were affected with ductal carcinoma in situ, 122 by invasive carcinoma of no special type, and 19 with invasive lobular carcinoma. Out of a total of 141 invasive cancers, 45 were luminal A-like, 54 luminal B-like, 5 human epidermal growth factor receptor 2 (HER2) positive, and 37 triple negative. The regression analyses showed that size < 2 cm predicted luminal A-like status (p = 0.025), while rim enhancement (p < 0.001), intralesional necrosis (p = 0.001), peritumoural oedema (p < 0.001), and axillary adenopathies (p = 0.012) were negative predictors. Oppositely, round shape (p = 0.001), rim enhancement (p < 0.001), intralesional necrosis (p < 0.001), and peritumoural oedema (p < 0.001) predicted triple-negative status.

Conclusions

mpMRI has been confirmed to be a valid noninvasive predictor of BC subtypes, especially luminal A and triple negative. Considering the central role of pathology in BC diagnosis and immunohistochemical profiling in the current precision medicine era, a detailed radiologic-pathologic correlation seems vital to properly evaluate BC.

Comparison of Ultrasound Features With Maximum Standardized Uptake Value Assessed by 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography for Prognosis of Estrogen Receptor+/Human Epithelial Growth Factor Receptor 2- Breast Cancer

ABSTRACT

estrogen receptor (ER)+/human epithelial growth factor receptor 2 (HER2)- breast cancers have less aggressive traits and a favorable prognosis when treated early. Prediction of prognosis for treatment outcome or survival in ER+/HER2- cancer is important. Ultrasound (US) is an effective and easy technique for breast cancer diagnosis and tumor characterization. Positron emission tomography/computed tomography (PET/CT) is widely used for diagnosis, staging, and therapeutic response in cancer evaluation, and a high maximum standardized uptake value (SUVmax) is associated with poor prognosis. The study aim was to compare the prognostic value of US features with that of the SUVmax assessed by PET/CT in ER+/HER- breast cancer patients. We retrospectively identified breast cancer patients in our institutional database who had undergone preoperative US and PET/CT, and 96 patients with invasive ductal carcinoma and ductal carcinoma in situ were included in this study. The US features of mass shape, margin, echo pattern, orientation, posterior features, boundary, and calcification in the mass were analyzed. We then analyzed the US features to look for correlations with SUVmax and associations with margins, boundaries, posterior features, histological grade, and ki-67 expression. High SUVmax was correlated with irregular shape, not-circumscribed margin, posterior acoustic enhancement, echogenic halo, and calcification in the mass (P < 0.05, all). Posterior acoustic enhancement was correlated with high ki-67 expression. Many US features of ER+/HER- breast cancer showed associations with SUVmax. Some US features of ER+/HER- breast cancer were useful for predicting prognosis.

Predicting the molecular subtype of breast cancer and identifying interpretable imaging features using machine learning algorithms

OBJECTIVES

To evaluate the performance of interpretable machine learning models in predicting breast cancer molecular subtypes.

METHODS

We retrospectively enrolled 600 patients with invasive breast carcinoma between 2012 and 2019. The patients were randomly divided into a training (n = 450) and a testing (n = 150) set. The five constructed models were trained based on clinical characteristics and imaging features (mammography and ultrasonography). The model classification performances were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), accuracy, sensitivity, and specificity. Shapley additive explanation (SHAP) technique was used to interpret the optimal model output. Then we choose the optimal model as the assisted model to evaluate the performance of another four radiologists in predicting the molecular subtype of breast cancer with or without model assistance, according to mammography and ultrasound images.

RESULTS

The decision tree (DT) model performed the best in distinguishing triple-negative breast cancer (TNBC) from other breast cancer subtypes, yielding an AUC of 0.971; accuracy, 0.947; sensitivity, 0.905; and specificity, 0.941. The accuracy, sensitivity, and specificity of all radiologists in distinguishing TNBC from other molecular subtypes and Luminal breast cancer from other molecular subtypes have significantly improved with the assistance of DT model. In the diagnosis of TNBC versus other subtypes, the average sensitivity, average specificity, and average accuracy of less experienced and more experienced radiologists increased by 0.090, 0.125, 0.114, and 0.060, 0.090, 0.083, respectively. In the diagnosis of Luminal versus other subtypes, the average sensitivity, average specificity, and average accuracy of less experienced and more experienced radiologists increased by 0.084, 0.152, 0.159, and 0.020, 0.100, 0.048.

CONCLUSIONS

This study established an interpretable machine learning model to differentiate between breast cancer molecular subtypes, providing additional values for radiologists.

KEY POINTS

• Interpretable machine learning model (MLM) could help clinicians and radiologists differentiate between breast cancer molecular subtypes. • The Shapley additive explanations (SHAP) technique can select important features for predicting the molecular subtypes of breast cancer from a large number of imaging signs. • Machine learning model can assist radiologists to evaluate the molecular subtype of breast cancer to some extent.

Analysis of breast cancer subtypes and their correlations with receptors and ultrasound

The study aim was to evaluate the ultrasound (US) signs of the mammary lesions classified in the Breast Imaging-Reporting and Data System (BI-RADS) score category 3, 4, and 5, corresponding to US BI-RADS. It also followed the correlation between US changes of lesions suggestive for malignancy with the histopathological results and evaluated the proper management of those lesions. There were correlations of breast cancer (BC) subtypes with the receptors [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)], and Ki67 index, and the signs of conventional ultrasonography and US elastography. We selected 108 female patients examined with US, mammography and fine-needle biopsy who presented suspicions for malignancy lesions. Following the immunohistochemical analysis, they were classified in one of the BC subtypes. According to chi-squared analysis of molecular cancer subtypes correlation to receptors and Ki67 index, we found significant associations between both luminal A and luminal B HER2-negative subtypes and hormone receptors (ER, PR). These have an inverse relationship with Ki67 index elevated values; luminal B HER2-positive subtype has a direct association with HER2 presence; HER2-enriched subtype was statistically significant associated to HER2 presence and elevated Ki67 index values but had an inverse relationship to hormone receptors (ER, PR); triple-negative subtype was strongly associated to Ki67 index values and inversely correlated to ER and PR. We found luminal A subtype as being the most common and luminal B HER2-positive subtype as having the fewer cases.

Are baseline mammographic and ultrasound features associated with metastasis free survival in women receiving neoadjuvant chemotherapy for invasive breast cancer?

OBJECTIVES

To identify associations between baseline ultrasound (US) and mammographic features and metastasis free survival (MFS) in women receiving neo-adjuvant chemotherapy (NACT) for breast cancer.

METHODS

The data were collected as part of an ethically approved prospective study. Women with invasive breast cancer receiving NACT who were metastasis free at diagnosis were included. Baseline US and mammography were performed. Imaging was assessed by an experienced breast radiologist who was blinded to outcomes. US imaging features documented included posterior effect, skin thickening, size and stiffness using shear wave elastography (SWE). The mammographic features documented were spiculation and microcalcification. The development of metastatic disease was ascertained from computer records. Statistical analysis was performed using Kaplan Meier survival curves and Receiver Operator Characteristic (ROC) analysis.

RESULTS

171 women with 172 cancers were included in the study and 55 developed metastatic disease. Mean follow-up was 6.0 years. Women with mammographic calcification had significantly poorer metastasis free survival (MFS) compared to women without calcification (p = 0.043, 6 yr MFS 50 % vs 69 %). Women bearing cancer with distal shadowing had poorer MFS than women without shadowing (p = 0.025, 6 yr MFS 47 % vs. 73 %). Women with US skin thickening had poorer MFS compared to women without skin thickening (p = 0.032, 6 yr MFS 52 % vs. 68 %). Mammographic spiculation, US size and stiffness at SWE had no significant association with MFS.

CONCLUSION

We have identified mammographic and US features associated with MFS in women receiving NACT. Such information may be useful when counselling patients about the benefits and risks of NACT.

Is There Any Association Between Mammographic Features of Microcalcifications and Breast Cancer Subtypes in Ductal Carcinoma In Situ?

RATIONALE AND OBJECTIVES

To analyze the association between mammographic features of microcalcifications and histopathological prognostic factors based on estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2/neu) in ductal carcinoma in situ (DCIS).

MATERIALS AND METHODS

We retrospectively determined 66 patients with microcalcification-associated pure DCIS. Distribution and morphological features of the microcalcifications were described using Breast Imaging Reporting and Data System lexicon. All patients were divided into three subgroups: ER-positive, HER-2 positive, and triple-negative according to the immunohistochemical findings.

RESULTS

The morphological features of microcalcifications and receptor subtypes were significantly correlated (p = 0.026). Fine pleomorphic and fine linear branching microcalcifications were observed in 85.2% of HER-2 positive cases, whereas this ratio was 71.4 % in ER-positive and 25% in the triple-negative group. Fine linear branching microcalcifications with linear or segmental distribution were more frequently found with comedo necrosis (p < 0.05). Larger tumour sizes were also associated with microcalcification distribution (p < 0.001). Segmental microcalcifications more likely associated with larger tumour sizes.

CONCLUSION

Mammographic features in DCIS correlated with immunohistochemical and histopathological prognostic factors.

Triple-negative breast cancer on contrast-enhanced MRI and synthetic MRI: A comparison with non-triple-negative breast carcinoma

PURPOSE

This study aimed to compare the characteristics of triple-negative breast cancer (TNBC) with non-TNBC on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and synthetic MRI.

METHOD

This retrospective study included 79 patients with histopathologically proven breast cancer (TNBC: 16, non-TNBC: 63) who underwent synthetic MRI. Using synthetic MR images, we obtained T1 and T2 relaxation times in breast lesions before (Pre-T1, Pre-T2, Pre-PD) and after (Gd-T1, Gd-T2, Gd-PD) contrast agent injection. Subsequently, we calculated the ΔT1 (Pre-T1 - Gd-T1), ΔT2 (Pre-T2 - Gd-T2), Pre-T1/T2, and Gd-T1/T2. We compared the aforementioned quantitative values, as well as several morphologic features between TNBCs and non-TNBCs that were identified on DCE-MRI.

RESULTS

The multivariate analyses revealed that the Pre-T2 (P = 0.037) and the presence of rim enhancement (P-RIM) (P = 0.034) were significant and independent predictors of TNBC. The area under the receiver operating characteristics curve for all breast cancers was greater when a combination of Pre-T2 and P-RIM (Pre-T2＋P-RIM; Method 3, AUC (area under the curve) = 0.858) was used to distinguish between TNBCs and non-TNBCs versus the use of either Pre-T2 alone (Method 1, AUC = 0.786) or P-RIM alone (Method 2, AUC = 0.747).

CONCLUSIONS

Pre-T2 obtained using synthetic MRI and P-RIM identified on DCE-MRI allowed the differentiation between TNBCs and non-TNBCs. However, these results are preliminary and need to be verified by further studies.

Predicting Molecular Subtypes of Breast Cancer with Mammography and Ultrasound Findings: Introduction of Sono-Mammometry Score

We studied the correlation of sonographic and digital mammographic features with molecular classification of breast cancer. Imaging features from 313 patients with preliminary ultrasound and digital mammogram between November 2017 and May 2020 were compared with histopathology and immunohistochemical analysis for the prediction of molecular classification of breast cancer. We also devised a score called “sono-mammometry” score consisting of few simple imaging features which can easily be performed in outpatient settings. We studied that non-triple-negative breast cancers are predominantly hypoechoic and strongly correlate with the presence of irregular spiculated margins along with peripheral echogenic halo, posterior shadowing, and microcalcifications, while there is considerable variation in imaging features of TNBC as some of its imaging features overlap with those of typical benign tumors. Although imaging characteristics are helpful in the prediction of molecular classification, the prognostication value of these imaging features is still weak. There is considerable variation in imaging features which warrants vigilance towards improved diagnostic performance. To help better understand these features, our sono-mammometry score can serve as straightforward test which is assumed to be functional and productive in resource-limited settings.

Mammographic and Sonographic Features of Breast Cancer in Women Before 30 Years of Age

BACKGROUND

Breast cancer uncommonly occurs in young women, but, tends to be diagnosed at a later stage and have a poorer prognosis than in older women. Standard screening guidelines for this age group are not established and the radiologic features of breast cancer in young women are not fully studied yet, because of the low incidence.

OBJECTIVES

To investigate the imaging findings for breast cancer in women aged 30 years or younger and to correlate them with clinicopathologic features and immunohistochemical subtypes.

METHODS

The study included 52 women with surgically confirmed breast cancer. The medical records of the patients were retrospectively reviewed and the mammographic and ultrasonographic findings were evaluated according to the fifth edition of the ACR BI-RADS lexicon.

RESULTS

Most of the tumors in this study were presented as a self-detected mass (42/52, 80.8%) and were of histologic grade III (31/43 invasive carcinoma, 72.1%) and the estrogen receptorpositive subtype (32/52, 61.5%). The most common mammographic finding was an irregular (19/24, 79.2%), indistinct (16/24, 66.7%), and hyperdense (20/24, 83.3%) mass. The ultrasonographic findings were of an irregular (32/47, 68.1%), indistinct (19/47, 40.4%), and hypoechoic/ heterogeneous (40/47, 85.1%) mass with no posterior features (34/47, 72.3%). An oval/round-shaped mass on ultrasonography was also correlated with triple-negative cancer (p=0.011).

CONCLUSION

On mammography and ultrasonography, breast cancer in young women usually presents as a mass with irregular shape and indistinct margin. Some radiologic findings could be used to predict the molecular phenotype of the tumor.

Can MRI Biomarkers Predict Triple-Negative Breast Cancer?

The purpose of this study was to investigate MRI features of triple-negative breast cancer (TNBC) compared with non-TNBC, to predict histopathological results. In the study, 26 patients with TNBC and 24 with non-TNBC who underwent multiparametric MRI of the breast on a 3 T magnet over a 10-months period were retrospectively recruited. MR imaging sets were evaluated by two experienced breast radiologists in consensus and classified according to the 2013 American College of Radiology (ACR) BI-RADS lexicon. The comparison between the two groups was performed using the Chi-square test and followed by logistic regression analyses. We found that 92% of tumors presented as mass enhancements (p = 0.192). 41.7% of TNBC and 86.4% of non-TNBC had irregular shape (p = 0.005); 58.3% of TNBC showed circumscribed margins, compared to 9.1% of non-TNBC masses (p = 0.001); 75% of TNBC and 9.1% of non-TNBC showed rim enhancement (p < 0.001). Intralesional necrosis was significantly associated with TNBC (p = 0.016). Rim enhancement and intralesional necrosis risulted to be positive predictors at univariate analysis (OR = 29.86, and 8.10, respectively) and the multivariate analysis confirmed that rim enhancement is independently associated with TNBC (OR = 33.08). The mean ADC values were significantly higher for TNBC (p = 0.011). In conclusion, TNBC is associated with specific MRI features that can be possible predictors of pathological results, with a consequent prognostic value.

Role of ultrasound in predicting the molecular subtypes of invasive breast ductal carcinoma

Background

Breast cancer is a heterogeneous disease that was explained recently by the presence of multiple molecular subtypes. These subtypes are the luminal A (LA), luminal B (LB), human epidermal growth factor receptor 2 (HER2), and triple-negative (TN). In this study, we aim to investigate whether ultrasound imaging features can play a role in predicting the molecular subtypes of invasive ductal breast cancer (IDC) and to assess whether the nodal metastasis is an independent predictor for each subtype.

Results

The predictive sonographic signs for each subtype are as follows: echogenic halo, posterior shadowing, angular or spiculated margin, and unifocal mass for LA subtype; irregular shape for LB subtype; unifocal mass, abrupt interface of the tumor boundary, and posterior enhancement or no posterior change for HER2 subtype; and circumscribed or lobulated margin, oval or rounded shape, posterior enhancement or no posterior change, abrupt interface of the tumor boundary, and parallel orientation of the mass for TN. By multivariate logistic regression, presence of nodal metastasis is the strongest independent predictor for HER2 subtype, and its absence is the strongest independent predictor for LA subtype.

Conclusions

Certain sonographic signs are predictors for each molecular subtype of IDC. Nodal metastasis is an independent predictor for HER2 subtype when present and for LA subtype when absent.

Accuracy of tumor size measurement on shear wave elastography (SWE): Correlation with histopathologic factors of invasive breast cancer

The aim of this study is to investigate the accuracy of tumor size assessment by shear wave elastography (SWE) in invasive breast cancer and also evaluated histopathologic factors influencing the accuracy.A total of 102 lesions of 102 women with breast cancers of which the size was 3 cm or smaller were included and retrospectively analyzed. Tumor size on B-mode ultrasound (US) and SWE were recorded and compared with the pathologic tumor size. If tumor size measurements compared to pathological size were within ±3 mm, they were considered as accurate. The relationship between the accuracy and histopathologic characteristics were evaluated.The mean pathologic tumor size was 16.60 ± 6.12 mm. Tumor sizes on SWE were significantly different from pathologic sizes (18.00 ± 6.71 mm, P < 0.001). The accuracy of SWE (69.6%) was lower than that by B-mode US (74.5%). There was more size overestimation than underestimation (23.5% vs 6.9%) using SWE. Conversely, there was more size underestimation than overestimation (18.6% vs 6.9%) using B-mode US. The accuracy of SWE was associated with ER positivity (P = .004), PR positivity (P = .02), molecular subtype (P = .02), and histologic grade (P = .03). In the multivariate analysis, ER positivity (P = .002) and molecular subtype (P = .027) significantly influenced the accuracy of tumor size measurement by SWE.In conclusion, the accuracy of the tumor size measured with SWE was lower than that measured with B-mode US and SWE tends to overestimate the size. ER positivity and molecular subtype are significantly associated with the accuracy of SWE in tumor size assessment.

Annexin A1-dependent tethering promotes extracellular vesicle aggregation revealed with single-extracellular vesicle analysis

Extracellular vesicles (EVs) including plasma membrane-derived microvesicles and endosomal-derived exosomes aggregate by unknown mechanisms, forming microcalcifications that promote cardiovascular disease, the leading cause of death worldwide. Here, we show a framework for assessing cell-independent EV mechanisms in disease by suggesting that annexin A1 (ANXA1)-dependent tethering induces EV aggregation and microcalcification. We present single-EV microarray, a method to distinguish microvesicles from exosomes and assess heterogeneity at a single-EV level. Single-EV microarray and proteomics revealed increased ANXA1 primarily on aggregating and calcifying microvesicles. ANXA1 vesicle aggregation was suppressed by calcium chelation, altering pH, or ANXA1 neutralizing antibody. ANXA1 knockdown attenuated EV aggregation and microcalcification formation in human cardiovascular cells and acellular three-dimensional collagen hydrogels. Our findings explain why microcalcifications are more prone to form in vulnerable regions of plaque, regulating critical cardiovascular pathology, and likely extend to other EV-associated diseases, including autoimmune and neurodegenerative diseases and cancer.

Associations between the ultrasound features of invasive breast cancer and breast cancer specific survival

AIM

To assess whether ultrasound features of breast cancer are associated with breast cancer specific survival (BCSS).

MATERIALS AND METHODS

Within a single breast service, data was collected prospectively (April 2010-April 2012) from 319 consecutive women (mean age 63 years) with 335 ultrasound-visible invasive breast cancers. Ultrasound features were evaluated retrospectively from the recorded images according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon by a radiologist blinded to outcomes. Survival and cause of death were ascertained from local and national sources. Kaplan-Meier survival curves were generated, and statistical significance tested using the log-rank test.

RESULTS

Mean follow-up in those alive was 80.9 months. Thirty breast cancer deaths and 45 non-breast cancer deaths occurred. Five-year BCSS in the presence of distal acoustic enhancement was 76% compared to 88%, 96%, and 100% for those with distal shadowing, no distal effect or combined effect respectively (p<0.0002). Patients with sonographic skin involvement had 73% 5-year BCSS compared to 92% for no skin involvement (p<0.0001). Focal oedema was associated with 56% 5-year BCSS compared to 89% for those without (p=0.0002). A significant association was demonstrated between ultrasound tumour size and BCSS (p<0.0001). At multivariate analysis, skin changes, distal enhancement, and focal oedema maintained prognostic significance.

CONCLUSION

Distal enhancement, focal oedema, and skin involvement have strong associations with breast cancer death. These factors could be taken into account, along with lesion size and other commonly used preoperative prognostic features, when considering management of women with breast cancer.

Tumor size estimation of the breast cancer molecular subtypes using imaging techniques

Background and aim

In medical practice the classification of breast cancer is most commonly based on the molecular subtypes, in order to predict the disease prognosis, avoid over-treatment, and provide individualized cancer management. Tumor size is a major determiner of treatment planning, acting on the decision-making process, whether to perform breast surgery or administer neoadjuvant chemotherapy. Imaging methods play a key role in determining the tumor size in breast cancers at the time of the diagnosis.

We aimed to compare the radiologically determined tumor sizes with the corresponding pathologically determined tumor sizes of breast cancer at the time of the diagnosis, in correlation with the molecular subtypes.

Methods

Ninety-one patients with primary invasive breast cancer were evaluated. The main molecular subtypes were luminal A, luminal B, HER-2 positive, and triple-negative. The Bland-Altman plot was used for presenting the limits of agreement between the radiologically and the pathologically determined tumor sizes by the molecular subtypes.

Results

A significantly proportional underestimation was found for the luminal A subtype, especially for large tumors. The p-values for the magnetic resonance imaging, mammography, and ultrasonography were 0.020, 0.030, and <0.001, respectively. No statistically significant differences were observed among the radiologic modalities in determining the tumor size in the remaining molecular subtypes (p>0.05).

Conclusion

The radiologically determined tumor size was significantly smaller than the pathologically determined tumor size in the luminal A subtype of breast cancers when measured with all three imaging modalities. The differences were more prominent with ultrasonography and mammography. The underestimation rate increases as the tumor gets larger.

Conventional US and 2-D Shear Wave Elastography of Virtual Touch Tissue Imaging Quantification: Correlation with Immunohistochemical Subtypes of Breast Cancer

Our study aimed to investigate the correlation of the imaging features obtained using conventional ultrasound (US) and elastography (conventional strain elastography of elasticity imaging [EI], virtual touch tissue imaging [VTI] and 2-D shear wave elastography [2-D-SWE] of virtual touch tissue imaging quantification [VTIQ]) with the clinicopathologic features and immunohistochemical (IHC) subtypes of breast cancer. The sample consisted of images from 202 patients with 206 breast lesions that were confirmed as breast cancers. Lesions with HER2 overexpression (luminal B HER2+ or HER2+) had higher mean shear wave velocity (SWV) values than the others. Older patients, lower histologic grade, no lymphovascular invasion and no lymph node metastasis were associated with luminal A (p < 0.001). There were significant differences in SWV values, histologic grade and lymph node status among the different pathologic types. This association may allow the use of 2-D-SWE in the pre-operative prediction of tumor characteristics and biologic activity, which may determine the prognosis in a non-invasive manner.

Ultrasound Findings in Three Complex Cystic Breast Carcinomas: Correlation with Intrinsic Tumor Subtype

In ultrasound examinations, mixed mammary gland masses are divided into either intracystic masses that contain a solid component in the cyst or solid masses that contain a fluid component in the mass. The histological types and subtypes of three complex cystic masses that showed different internal compositions in ultrasound were determined using the ultrasound findings of three patients. Case 1: The mass showed a large cystic component (bleeding) inside and a broad-based solid lesion at the margin in the ultrasound finding. The histological type was encapsulated papillary carcinoma and the subtype was luminal A. Case 2: The mass was lobulated with a small cystic component at the margin. The histological type was solid papillary carcinoma and the subtype was luminal A. Case 3: The mass was lobulated with a circumscribed margin. Cystic components suspected of being hemorrhagic necrosis were observed at the margin and within the solid component. The histological type was squamous cell carcinoma and the subtype was triple negative. Case 2 was a solid mass in appearance, but a cystic component noted at the margin was possibly an intracystic mass. For Case 3, findings suggestive of necrosis were observed both at the margin and in the solid component and this suggested a mass with fluid degeneration. Complex cystic masses are usually examined with a focus on the solid component seen on ultrasound images; however, it is also important to observe the cystic composition. This can help determine the subtypes in addition to the histological types.

Predicting the molecular subtype of breast cancer based on mammography and ultrasound findings

AIM

To determine the correlation between mammography and ultrasound features of breast cancer with molecular subtypes and to calculate the predictive value of these features.

MATERIALS AND METHOD

This is a prospective study of consecutive patients with breast cancer presenting between January 2016 and July 2017, who underwent mammography and/or ultrasound of breast and excision of the breast mass. Patients with contralateral breast mass, metastases, h/o prior cancer treatment, and other malignancies were excluded. On mammography, the presence or absence of microcalcification was noted. On ultrasound examination size, margins, microcalcification, posterior acoustic features, vascularity, and axillary nodes were assessed. Margins were categorized into circumscribed and non-circumscribed. Posterior acoustic features were classified into four categories: shadowing, enhancement, mixed, and no changes. Vascularity was assessed based on Adler's index into grades 0, 1, 2, and 3. Grades 0 and 1 were considered low and 2 and 3 were high.

RESULTS

Tumors with non-circumscribed margins and posterior acoustic shadowing were likely to be luminal A or B subtype of breast cancer [odds ratio (OR) 5.78; 95% confidence interval (CI) 3.68-9.80; P < 0.0001]. Tumors with non-circumscribed margins, posterior acoustic shadowing, and high vascularity were more likely to be luminal B subtype (OR 2.88; 95% CI 2-4.14; P- <0.0001). Tumors with microcalcification and posterior mixed acoustic pattern were strongly associated to be HER2-positive (OR 5.48; 95% CI 3.06-9.80; P < 0.0001). Tumors with circumscribed margins and posterior acoustic enhancement were highly suggestive of triple-negative breast cancer (OR 7.06; 95% CI 4.64-10.73; P < 0.0001).

CONCLUSION

Microcalcification detected on mammography and certain ultrasound features such as circumscribed or non-circumscribed margins, posterior acoustic features, and vascularity are strongly correlated in predicting the molecular subtypes of breast cancer, and thus may further expand the role of conventional breast imaging.

Do Histopathological Features and Microcalcification Affect the Elasticity of Breast Cancer?

OBJECTIVES

The aim of this study was to evaluate any association between histological grade, molecular subtypes of breast cancer, and strain elastography, and to investigate whether microcalcification affects the stiffness of tumor in breast cancers with the same histological grade.

METHODS

Between April 2015 and March 2016, 94 lesions of 94 patients with the diagnosis of invasive ductal carcinoma were included in the study. Strain elastography was performed on all patients before biopsy. Histological grades (Grades 1, 2, and 3), molecular subtypes (luminal A, luminal B, Her-2, and basal-like), and strain ratio (SR) were compared. In the same histological grades, patients were divided into two groups according to the presence of microcalcifications, and the groups were compared with each other.

RESULTS

Compared with Grades 1 (20.5) and 2 (23.7), Grade 3 (11.7) showed lower SR values (Grade 3-2, P = .01; Grade 3-1, P = .2). The groups with microcalcification had slightly higher SR in all histological grades, but not of statistical significance. In molecular subtypes, luminal A and B demonstrated higher SR, whereas HER2 and basal-like had lower SR (P > .05 for all group comparisons).

CONCLUSIONS

Grade 3 invasive ductal carcinomas are different from other grades with lower SR values. The presence of microcalcifications and molecular subtypes do not affect elasticity like a high histological grade does.

The role of ultrasonographic findings to predict molecular subtype, histologic grade, and hormone receptor status of breast cancer

PURPOSE

The correlation between imaging findings and pathologic characteristics of tumors may provide information for diagnosis and treatment of cancer. The aim of this study is to determine whether ultrasound features of breast cancer are associated with molecular subtype, histologic grade, and hormone receptor status, as well as assess the predictive value of these features.

METHODS

A total of 201 consecutive invasive breast cancer patients were reviewed from the database according to the Breast Imaging and Reporting Data System (BI-RADS). Tumor margins were classified as circumscribed and noncircumscribed. Noncircumscribed group was divided into indistinct, spiculated, angular, and microlobulated. The posterior acoustic features were divided into four categories: shadowing, enhancement, no change, and mixed pattern.

RESULTS

Tumors with posterior shadowing were more likely to be of nontriple negative subtype (odds ratio [OR], 7.42; 95% CI, 2.10-24.99; P = 0.002), low histologic grade (grade 1 or 2 vs. grade 3: OR, 2.42; 95% CI, 1.34-4.35; P = 0.003) and having at least one positive receptor (OR, 3.36; 95% CI, 1.55-7.26; P = 0.002). Tumors with circumscribed margins were more often triple-negative subtype (OR, 6.72; 95% CI, 2.56-17.65; P < 0.001), high grade (grade 3 vs. grade 1 or 2: OR, 5.42; 95% CI, 2.66-11.00; P < 0.001) and hormone receptor negative (OR, 4.87; 95% CI, 2.37-9.99; P < 0.001).

CONCLUSION

Sonographic features are strongly associated with molecular subtype, histologic grade, and hormone receptor status of the tumor. These findings may separate triple-negative breast cancer from other molecular subtypes.

Engineered Breast Cancer Cell Spheroids Reproduce Biologic Properties of Solid Tumors

Solid tumors develop as 3D tissue constructs. As tumors grow larger, spatial gradients of nutrients and oxygen and inadequate diffusive supply to cells distant from vasculature develops. Hypoxia initiates signaling and transcriptional alterations to promote survival of cancer cells and generation of cancer stem cells (CSCs) that have self-renewal and tumor-initiation capabilities. Both hypoxia and CSCs are associated with resistance to therapies and tumor relapse. This study demonstrates that 3D cancer cell models, known as tumor spheroids, generated with a polymeric aqueous two-phase system (ATPS) technology capture these important biological processes. Similar to solid tumors, spheroids of triple negative breast cancer cells deposit major extracellular matrix proteins. The molecular analysis establishes presence of hypoxic cells in the core region and expression of CSC gene and protein markers including CD24, CD133, and Nanog. Importantly, these spheroids resist treatment with chemotherapy drugs. A combination treatment approach using a hypoxia-activated prodrug, TH-302, and a chemotherapy drug, doxorubicin, successfully targets drug resistant spheroids. This study demonstrates that ATPS spheroids recapitulate important biological and functional properties of solid tumors and provide a unique model for studies in cancer research.

Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions

PURPOSE

Ultrasound (US) is a well-established diagnostic procedure for breast examination. We investigated the malignancy rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. We examined whether patient history and clinical findings could provide additional information that would help determine further diagnostic steps in breast lesions.

MATERIALS AND METHODS

We conducted a retrospective study by exploring US BI-RADS in 1469 breast lesions of 1201 patients who underwent minimally invasive breast biopsy (MIBB) from January 2002 to December 2011.

RESULTS

The overall sensitivity and specificity of BI-RADS classification was 97.4% and 66.4%, respectively, with a positive (PPV) and negative predictive value (NPV) of 65% and 98%, respectively. In 506 BI-RADS 3 lesions, histology revealed 15 malignancies (2.4% malignancy rate), which corresponds to a false-negative rate (FNR) of 2.6%. Clinical evaluation and patient requests critically influenced the further diagnostic procedure, thereby prevailing over the recommendation given by the BI-RADS 3 classification.

CONCLUSION

Clinical criteria including age, family and personal history, clinical examination, mammography and patient choice ensure adequate diagnostic procedures such as short-term follow-up or MIBB in patients with lesions classified as US-BI-RADS 3.

Immunohistochemical Subtypes of Breast Cancer: Correlation with Clinicopathological and Radiological Factors

BACKGROUND

The relationship between biomarkers and imaging features is important because imaging findings can predict molecular features.

OBJECTIVES

To investigate the relationship between clinicopathologic and radiologic factors and the immunohistochemical (IHC) profiles associated with breast cancer.

PATIENTS AND METHODS

From December 2004 to September 2013, 200 patients (mean age, 56 years; range, 29 - 82 years) were diagnosed with breast cancer and underwent surgery at our institution. Their medical records were reviewed to determine age, symptom presence, mammographic findings (including mass, asymmetry, microcalcifications, or negativity), sonographic Breast Imaging-Reporting and Data System (BI-RADS) category, pathologic type of cancer (invasive ductal, mucinous, medullary, or papillary carcinoma), histologic grade, T-stage, and IHC subtypes. Based on the IHC profiles, tumor subtypes were classified as luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) enriched, or triple-negative (TN) cancers. Using univariate and multivariate logistic regression analyses, we looked for correlations between four IHC subtypes and two IHC subtypes (TN and non-triple negative [non-TN]) and clinicopathologic and radiologic factors, respectively.

RESULTS

Based on our univariate analyses with the four subtypes, the TN subtype showed a higher incidence of masses on mammography compared to the other subtypes (P = 0.037), and the TN subtype also tended to have the highest histologic grade among the subtypes (P < 0.001). With regard to the two IHC subtypes, the TN subtype had a significant association with medullary cancer (P = 0.021), higher histologic grade (grade 3; P < 0.001), and higher T stage (T2; P = 0.027) compared to the non-TN subtypes. In a multivariate logistic regression analysis of the clinicoradiologic factors compared to luminal A, the HER2 subtype had a significant association with BI-RADS category 4b (odds ratio [OR], 9.005; 95% confidence interval [CI], 1.414 - 57.348; P = 0.020) and borderline significance with category 4c (OR, 4.669; 95% CI, 0.970 - 22.468; P = 0.055). In a multivariate logistic regression analysis of the clinicoradiologic factors associated with the non-TN subtypes, the TN subtype was significantly correlated with medullary carcinoma (OR, 7.092; 95% CI, 1.149 - 43.772; P = 0.035).

CONCLUSION

These results suggest that patients with the TN subtypes are more likely to have higher-histologic-grade tumors and medullary cancer. The HER2 subtype was typically associated with a higher BI-RADS category.

Role of MRI in the staging of breast cancer patients: does histological type and molecular subtype matter?

OBJECTIVE

To assess the role of MRI in the pre-operative staging of patients with different histological types and molecular subtypes of breast cancer, by the assessment of the dimensions of the main tumour and identification of multifocal and/or multicentric disease.

METHODS

The study included 160 females diagnosed with breast cancer who underwent breast MRI for pre-operative staging. The size of the primary tumour evaluated by MRI was compared with the pathology (gold standard) using the Pearson's correlation coefficient (r). The presence of multifocal and/or multicentric disease was also evaluated.

RESULTS

The mean age of patients was 52.6 years (range 30-81 years). Correlation between the largest dimension of the main tumour measured by MRI and pathology was worse for non-special type/invasive ductal carcinoma than for other histological types and was better for luminal A and triple-negative than for luminal B and Her-2 molecular subtypes. Multifocal and/or multicentric disease was present in 48 patients (30.0%), and it was more common in breast carcinomas classified as Her-2 molecular subtype. There was no statistically significant difference in the frequency of multifocal and/or multicentric tumours identified only by MRI in relation to histological type or molecular subtype.

CONCLUSION

The results of this retrospective study demonstrated that histological types and molecular subtypes might influence the MRI assessment of breast cancers, especially in the evaluation of tumour size.

ADVANCES IN KNOWLEDGE

The real benefit of MRI for treatment planning in patients with breast cancer may be different according to the histological type and molecular subtype.

Elastographic features of triple negative breast cancers

OBJECTIVES

To evaluate shear-wave elastographic (SWE) features of triple negative breast cancers (TNBC) and determine useful discriminators from other types of invasive breast cancers.

METHODS

SWE features of 26 TNBC were reviewed and compared to 32 non-TNBC. Qualitative SWE features of lesion colour appearance, shape and homogeneity were analysed. Quantitative features were measured: mean (El mean), maximum (El max) and minimum (El min) elasticity value of the stiffest portion of the mass, mean elasticity of the surrounding tissue (El mean surr) and lesion to fat elasticity ratio (E ratio).

RESULTS

TNBC are more often regularly shaped (57.7 % vs. 6.2 %), while non-TNBC are more commonly red (93.7 % vs 42.3 %) and heterogeneous (68.7 % vs 42.3 %). The stiffness of TNBC is significantly lower compared to non-TNBC. The two groups could be distinguished on the basis of El max (p = 0.001), El mean (p = 0.001), El min (p = 0.001) and E ratio (p = 0.0017). Lesion to fat elasticity ratio in TNBC group was statistically significantly lower than in the non-TNBC control group (p = 0.009).

CONCLUSIONS

TNBC often demonstrate benign morphological features, are softer on SWE and have a lower lesion to fat stiffness ratio compared to the other, more common types of invasive breast cancers.

KEY POINTS

• TNBC often demonstrate benign morphological features on SWE. • TNBC present on elastography mostly as red, regularly shaped, heterogeneous lesions. • TNBC are less stiff compared to other invasive breast cancers. • TNBC have lower lesion to fat stiffness ratio than other breast cancers.

Breast cancer in very young women (<30 years): Correlation of imaging features with clinicopathological features and immunohistochemical subtypes

OBJECTIVE

Early diagnosis of breast cancer in very young women (<30 years) is challenging and the characteristic imaging findings are not yet fully understood. We evaluated the imaging findings of breast cancer in very young women (<30 years) and to correlate them with clinicopathological features.

MATERIAL AND METHODS

A total of 50 surgically confirmed breast cancers were included in our retrospective study. The medical records were reviewed and the radiological features were analyzed according to the new 5th edition of the ACR BI-RADS lexicon.

RESULTS

The breast cancers in our study population most commonly presented as a self-detected mass (74%), T2-3 stage (58%), histological grade III (52.3%) and ER-positive (80%) subtype. The most common finding was an irregular (87.5%) hyperdense (66.7%) mass with indistinct margins (50%) on mammography and an irregular (75.6%) indistinct (57.8%) hypoechoic/heterogeneous (77.8%) mass without a posterior acoustic feature (60%) on ultrasonography. MRI revealed an irregular shape (63.3%), irregular margins (43.3%), and heterogeneous enhancement (60%) with washout kinetics (69.4%). Mammographically, microcalcifications were correlated with the HER2-enriched type, and mass-type lesions were correlated with triple-negative cancer (p=0.04). An oval/round mass on ultrasound (p=0.005), rim enhancement (p=0.004) and intralesional T2 high signal intensity (p=0.04) on MRI were associated with the triple-negative type.

CONCLUSIONS

On all imaging modalities, breast cancer in very young women usually presented as an irregular mass, and certain radiological features could be used for predicting the specific tumor type.

Mammographic and sonographic features of triple-negative invasive carcinoma of no special type

The aim of this study was to compare the mammography, ultrasound (US) and histologic features of triple-negative (TN) invasive carcinoma of no special type (NST) to non-TN invasive carcinoma of NST. The second aim was to assess whether the distinct imaging characteristics of TN breast cancer would persist after controlling for the histologic features. A total of 344 invasive carcinomas of NST in 337 patients from January 2007 to February 2008 were included in this study. Two radiologists retrospectively reviewed the mammography and US findings using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon and our institution's criteria. On mammography, TN invasive carcinoma of NST most commonly presented as a mass with round shape and non-spiculated margin. On US, it was more likely to have internal hypoechogenicity, an abrupt boundary and posterior acoustic enhancement. TNBC lacked major suspicious imaging findings such as an irregular shape, spiculated margin and calcification.

Mammographic and clinicopathological features of triple-negative breast cancer

OBJECTIVE

Triple-negative breast cancer (TNBC) lacks effective treatment and has a poor prognosis. This study assessed mammographic findings and clinicopathological features of TNBC by comparing with non-TNBC in order to improve clinical diagnosis of TNBC.

METHODS

A total of 426 patients with pathologically confirmed breast cancer were retrospectively assigned into two groups, TNBC (n = 54) and non-TNBC (n = 372), and then analysed.

RESULTS

TNBC frequently showed a high histological grade, presented with a mass (79.6%) and was less frequently associated with focal asymmetric density (11.1%), microcalcifications (5.6%) and distortion (3.7%) on mammography. TNBC mammographic masses were most frequently round/oval (58.1%) or lobular (30.2%) in shape and were less frequently irregular in shape (11.6%). Masses with circumscribed margins were the most frequent (37.2%), with microlobulated (25.6%) and obscured (16.3%) margins being commonly observed, but masses with spiculated margins were rare (9.3%).

CONCLUSION

TNBC could have distinct mammographic and clinicopathological features compared with non-TNBC, and thus mammography may be useful in the diagnosis of TNBC.

ADVANCES IN KNOWLEDGE

This study demonstrated distinct mammographic and clinicopathological features to help in diagnosis of Chinese patients with TNBC.

Correlation between imaging and prognostic factors: molecular classification of breast cancers

The new molecular classification of breast cancers defines cancer sub-groups with a distinct prognosis and response to treatment. Studies on the literature deal with the imaging of each tumour sub-type. The radiologist should be familiar with them in order to adapt the care of an aggressive sub-type. In view of the current knowledge, the following have been significantly more often observed: mammographical spiculated mass with echogenic halo in luminal A sub-type; architectural distortion in luminal B sub-type; an irregular mass with indistinct margin comprising microcalcifications, with an abrupt interface in the sonography, or non-sonographic mass in the HER2 sub-type; a very hypoechogenic, lobulated mass with indistinct or microlobulated margin, with an abrupt interface, sometimes pseudo-benign, in the triple-negative sub-type.

Imaging features of sporadic breast cancer in women under 40 years old: 97 cases

OBJECTIVES

To evaluate characteristic features of mammography, ultrasound and magnetic resonance imaging (MRI) of sporadic breast cancer in women <40 years and to determine correlations with pathological and biological factors.

METHODS

A retrospective review of radiological, clinicopathological and biological features of sporadic breast cancers for women under 40 years at our institution between 2007-2012 covering 91 patients. Mammography was available for 97 lesions, ultrasound for 94 and MRI for 38.

RESULTS

The most common imaging features were masses, nearly all classified BI-RADS 4 or 5. On mammography microcalcifications alone accounted for 31 %, all suspicious. There were 42.6 % luminal B, 24.5 % luminal A, 19.1 % HER2-enriched and 10.6 % triple-negative (TN) tumours by immunohistochemistry. HER2 overexpression was correlated with the presence of calcifications at mammography (P = 0.03). TN cancers more often had an oval shape and abrupt interface at ultrasound and rim enhancement on MRI. MRI features were suspicious for all cancers and rim enhancement of a mass was a significant predictor of triple-negative tumours (P = 0.01).

CONCLUSIONS

The imaging characteristics of cancers in patients under 40 years without proven gene mutations do not differ from their older counterparts, but appear correlated to phenotypic profiles, which have a different distribution in young women compared to the general population.

Correlation between imaging and molecular classification of breast cancers

The histological type of tumour according to the WHO: ductal, lobular, rare forms, is correlated with specific aspects of the imaging based on each type. This morphological classification was improved by knowledge of the molecular anomalies of breast cancers, resulting in the definition of cancer sub-groups with distinct prognoses and different responses to treatment: luminal A, luminal B, HER2 positive, basal-like, triple-negative. Studies are beginning to deal with the appearance of each sub-type in the imaging. It is now important for the radiologist to be familiar with them.

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

BACKGROUND

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 = 105) and HR-positive/HER-2-negative breast cancers (n = 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.