Imaging Findings and Clinicopathological Correlation of Breast Cancer in Women under 40 Years Old

Correlation between ultrasonography and elastography parameters and molecular subtypes of breast cancer in young women

OBJECTIVE

To explore the differences of conventional ultrasound characteristics, elastic imaging parameters and clinicopathological characteristics of distinct molecular subtypes of breast cancer in young women, and to identify imaging parameters that exhibited significant associations with each molecular subtype.

METHODS

We performed a retrospective analysis encompassing 310 young women with breast cancer. Observations were made regarding the ultrasonography and elastography characteristics of the identified breast lesions. Subsequently, based on immunohistochemistry results patients were classified into five distinct molecular subtypes: luminal A, luminal B (HER2-), luminal B (HER2+), HER2+, and triple-negative breast cancer (TNBC). Clinical, pathological, and ultrasound imaging features were compared among these subtypes using binary logistic regression analysis.

RESULTS

Statistically significant differences were observed in various parameters across the five molecular subtypes (p < 0.05), including tumor size, morphology, margins, calcification, posterior echo features, blood flow (Adler grading), and tumor hardness. Specifically, luminal A subtype exhibited propensity for spiculated margins, lower blood flow grading, and decreased hardness; luminal B subtype was characterized by angular margins; HER2+ subtype manifested higher blood flow grading, calcification, and elevated hardness. Conversely, TNBC subtype displayed smooth margins, absence of calcification, and heightened hardness.

CONCLUSION

Specific molecular subtypes of breast cancer have unique ultrasonic and elastic imaging characteristics.

Imaging Patterns in Breast Cancer for Women Under 40 Years: A Descriptive Cohort Study

BACKGROUND AND AIM

Breast cancer is the most frequently occurring malignant disease in women and remains the leading cause of cancer-related deaths among females worldwide. The aim of this study is to evaluate the imaging findings of breast cancer in women under the age of 40 and analyze their pathological patterns.

METHOD

A retrospective study was conducted from 2013 to 2019, involving 120 patients below 40 years of age with pathologically confirmed primary epithelial breast cancers. The data were collected from the electronic records of a tertiary hospital in Riyadh, Saudi Arabia. Mammograms were performed for 115 patients, ultrasounds were conducted for all patients, and MRI scans were carried out for 47 patients.

RESULTS

All radiological findings and clinical characteristics of the 120 cases were retrieved from our digital-based system. The majority of breast cancer patients (83.4%) were between 30 and 40 years old, and the most common clinical presentation was a mass (45.8%). Out of the 73 patients who underwent genetic tests, 32.9% tested positive for gene mutations. No statistically significant correlation was found between specific age groups and breast composition (P = 0.216), specific mammogram abnormalities such as masses (P = 0.262), or microcalcifications (P = 0.421). Ultrasonography was performed for all patients, with abnormalities detected in only one patient who was diagnosed with Paget's disease of the nipple. Masses, with or without parenchymal changes, were the predominant feature in 88.3% of cases.

CONCLUSION

The imaging findings in breast cancer cases typically involve masses with suspicious features, irregular shape, and spiculated margins on mammograms, and irregular shape with microlobulated or angular margins on ultrasound. MRI features commonly include masses with irregular shape and heterogeneous enhancement. The luminal B subtype was identified as the most prevalent pathological feature, characterized by a high proliferative index (Ki-67%).

A Retrospective Study of the Epidemiology, Histomorphological Features, Hormonal Status, and Radiological Features of Breast Cancer Diagnosed on Biopsies in Women in Bahrain Up to the Age of 40: A Single-Center Study

BACKGROUND

Breast cancer is the most commonly diagnosed cancer in women worldwide. There are many risk factors that contribute to breast cancer which involve modifiable and non-modifiable factors. Most of the patients diagnosed with breast cancer are over 50 years of age, with breast cancer in women less than 40 years of age being relatively rare and typically more aggressive variants. Moreover, radiological examination is essential for diagnosis and triaging patients for further diagnostic procedures including tissue biopsy sampling. Despite the rarity of malignancy among the younger age group, all of their breast lesions are usually biopsied. Hence, this paper outlines the percentage of benign and malignant breast lesions detected on biopsies obtained from female patients who presented to our hospital before or at the age of 40.

METHODS

 We conducted a single institution retrospective study on 267 breast biopsies done for female patients before or at the age of 40 in the period from January 2020 to January 2023. The data was obtained from the National Health Information System at Salmaniya Medical Complex. The data collected included clinical history, histological, and radiological findings. Data on prognostic markers (estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status) were also included. The distribution of samples was established according to age ranges, pathological diagnostic categories (B1-5), and prognostic marker interpretation. Further subdivision was performed on cases with malignancy according to tumor grade. The frequency distribution was obtained for ER, PR, and HER status jointly. The association between age and grade, as well as age and categories, was also determined. All the analyses were performed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp), and the statistical significance was tested at a 5% level.

RESULTS

Out of 267 samples, the majority (62.9%) were in patients with a range of age between 30 and 40. There were 68.5% of samples with the B2 (benign) category, followed by 20.2% with the B5b (malignant-invasive carcinoma) category. Out of 61 malignant samples, there were 17 (6.4%) samples positive on ER and PR but negative on HER2, 16 (6.0%) samples negative on ER, PR, and HER2, eight (3.0%) samples negative on ER and PR negative but positive on HER2, and five (8.2%) samples positive on ER, PR, and HER2. The majority of malignant cases were of grade II which accounted for 29 (10.9%) samples, followed by 23 (8.6%) with grade III. The association between age and grade was statistically not significant (p=0.113). However, the association between age and B categories was statistically significant with a p-value of 0.0002. A significantly higher proportion of cases with B5a (malignant-in situ carcinoma) or B5b (malignant-invasive carcinoma) categories were in the age range of 31-35 years and 36-40 years.

CONCLUSION

Breast cancer is rare among younger women. It mostly occurs in women over the age of 40 years. In women under the age of 40, it usually presents as a self-detected palpable mass and can show various radiological findings in accordance with the histological grade. Ultrasonography is the main method for the diagnosis of breast cancer especially in younger women, whereas mammography and MRI can contribute to both diagnosis and assessment of the extent of the disease.

Breast cancer in a Hispanic patient with Werner syndrome

Werner Syndrome is a rare autosomal recessive condition characterized by premature aging and increased risk of malignancies due to gene mutations associated with DNA stability. We present the first case report of a 29-year-old Hispanic female with WS diagnosed with breast cancer. Diagnostic mammography and ultrasound, breast MRI and PET examinations revealed two lesions biopsy proven as invasive ductal carcinoma. The patient underwent neoadjuvant chemotherapy and radical mastectomy. Recurrence occurred 10 months postoperatively with molecular analysis demonstrating TP53 mutations. The multifactorial assessment of breast cancer in this case study is crucial towards optimizing screening, diagnosis and management of this disease in patients with WS.

Breast Cancer Screening Using a Modified Inertial Projective Algorithms for Split Feasibility Problems

To detect breast cancer in mammography screening practice, we modify the inertial relaxed CQ algorithm with Mann's iteration for solving split feasibility problems in real Hilbert spaces to apply in an extreme learning machine as an optimizer. Weak convergence of the proposed algorithm is proved under certain mild conditions. Moreover, we present the advantage of our algorithm by comparing it with existing machine learning methods. The highest performance value of 85.03% accuracy, 82.56% precision, 87.65% recall, and 85.03% F1-score show that our algorithm performs better than the other machine learning models.

The imaging findings and diagnostic value of radiology modalities to assess breast malignancy among women aged younger than 30 years

BACKGROUND

Breast cancer mainly affects women aged >50 years; however, younger women may also have advanced breast cancer, so early detection is important.

PURPOSE

To collect and review the imaging findings of women aged <30 years with breast cancer to find better diagnostic approaches for the early diagnosis of breast cancer in young women.

MATERIAL AND METHODS

In this study, 45 patients aged <30 years with a diagnosis of breast cancer were evaluated. Imaging assessments were performed based on ultrasound, mammography, and magnetic resonance imaging (MRI) findings. Finally, the findings were compared with the pathological results.

RESULTS

Predominant findings in ultrasound included irregular spiculated mass in 59.4%. In mammography, irregular high-density mass (46.5%) and suspicious micro calcification (42.8%) were the most common findings. In MRI, the predominant feature was a heterogeneous enhancing mass with an irregular shape and irregular margin (81%) with a 45% plateau and 36% washout kinetic pattern. In the pathology assessment, invasive ductal carcinoma was the most common finding (84.4%). All three modalities-MRI, ultrasonography, and mammography-are valuable, with sensitivities of 100%, 93.3%, and 90%, respectively.

CONCLUSION

Ultrasound, mammography, and MRI are highly sensitive and accurate tools for detecting breast cancer lesions in young women. Regular clinical breast examination with breast self-examination, and in suspected cases, ultrasound as the first imaging modality followed by mammography and/or MRI are the preferred diagnostic approach.

Type 2 dynamic curves: A diagnostic dilemma

BACKGROUND

Magnetic resonance imaging (MRI) with multiparametric dynamic contrast plays a critical role in the assessment of breast lesions. Dynamic curves are a critical parameter in determining the benign or malignant nature of lesions. Dynamic curves of type 1 are known to represent benign masses, while dynamic curves of type 3 are known to identify malignant masses. Type 2 dynamic curves have a sensitivity of 42.6% and specificity of 75% for malignancy detection.

AIM

To investigate the pathological diagnosis of lesions with type 2 dynamic curves.

METHODS

We evaluated breast MRI examinations performed between 2020 and 2021 retrospectively and included lesions with type 2 dynamic curves. We included 38 lesions from 33 patients. The lesions were evaluated for their pathological diagnosis and morphological characteristics.

RESULTS

Twenty-six lesions were malignant, while twelve were benign. The most frequently encountered benign lesion (7/12, 58.3%) was sclerosing adenosis, while the most frequently encountered malignant diagnosis was invasive ductal cancer. The presence of a type 2 dynamic curve had a sensitivity of 40.2% and specificity of 73.4% for predicting malignancy. By combining type 2 curves and morphological features, the sensitivity and specificity were increased.

CONCLUSION

The high rates of malignancy detected histopathologically among patients with type 2 dynamic curves in our study are remarkable. Type 2 dynamic curves can be detected in benign breast masses, especially in sclerosing adenosis cases. Considering morphological features can increase the diagnostic accuracy in cases with type 2 dynamic curves.

Breast involvement of hematological malignancies: imaging and clinical findings

Background

Breast involvement of hematological malignancies is a very rare entity. Accurate diagnosis is essential for appropriate treatment. The aim of this study was to clarify the clinical and radiological findings of hematological malignancy breast involvement and to describe possible pitfalls in diagnosis.

Results

The images of 20 patients with breast involvement of hematological malignancies were retrospectively evaluated on ultrasonography, mammography, and magnetic resonance imaging (MRI) and the findings were reported. Bilaterality was seen only in cases with secondary involvement, and there was no marked difference between primary and secondary breast involvement of hematological malignancies. All patients underwent ultrasonography examination. According to ultrasonography, breast masses were most frequently irregular in shape (11/20, 55%) with non-circumscribed margins (11/20, 55%). Posterior acoustic enhancement was noted in 14 cases (70%). Posterior shadowing was not observed in any of the patients. Mammography was available in 10 patients. Microcalcification was not observed in any patient on mammography. MRI was available in four patients. Hyperintensity in T2-weighted images, type 2 or type 3 dynamic curve, and diffusion restriction were observed in all cases.

Conclusions

Hematological malignancies may mimic both benign breast lesions and breast carcinoma. Familiarity with the radiological features of hematological malignancies can help accurate diagnosis.

Imaging characteristics of young age breast cancer (YABC) focusing on pathologic correlation and disease recurrence

The purpose of this study is to investigate imaging characteristics of young age breast cancer (YABC) focusing on correlation with pathologic factors and association with disease recurrence. From January 2017 to December 2019, patients under 40 years old who were diagnosed as breast cancer were enrolled in this study. Morphologic analysis of tumor and multiple quantitative parameters were obtained from pre-treatment dynamic contrast enhanced breast magnetic resonance imaging (DCE-MRI). Tumor-stroma ratio (TSR), microvessel density (MVD) and endothelial Notch 1 (EC Notch 1) were investigated for correlation with imaging parameters. In addition, recurrence associated factors were assessed using both clinico-pathologic factors and imaging parameters. A total of 53 patients were enrolled. Several imaging parameters derived from apparent diffusion coefficient (ADC) histogram showed negative correlation with TSR; and there was negative correlation between MVD and Ve in perfusion analysis. There were nine cases of recurrences with median interval of 16 months. Triple negative subtype and low CD34 MVD positivity in Notch 1 hotspots showed significant association with tumor recurrence. Texture parameters reflecting tumor sphericity and homogeneity were also associated with disease recurrence. In conclusion, several quantitative MRI parameters can be used as imaging biomarkers for tumor microenvironment and can predict disease recurrence in YABC.

Correlation between imaging features and molecular subtypes of breast cancer in young women (≤30 years old)

OBJECTIVES

To analyze the features of digital mammography (DM) plus digital breast tomosynthesis (DBT), ultrasonography (US) and magnetic resonance imaging (MRI) of breast cancer in young women (≤30 years old) and the correlation with molecular subtypes.

MATERIALS AND METHODS

We performed a retrospective study of imaging features of consecutive young women aged ≤30 years who were treated and surgically confirmed with breast cancer between January 2013 and December 2019 in our institution. All patients were Chinese women. DM + DBT and US were available for 170 lesions, MRI for 41 lesions. The imaging features were analysed by univariate and multivariate logistic regression analyses to find the predictive factors of the molecular subtypes.

RESULTS

The predictive factors of the luminal B(HER2-) subtype (n = 51) were the mass with microcalcifications, irregular shape, spiculated margins, and shadowing posterior features (all P < 0.01). The predictive factors of the luminal B(HER2+) subtype (n = 26) were the spiculated margins (DBT + DM), angular margins (US), shadowing posterior features, and high vascularity (all P < 0.05). The predictive factors of the luminal A subtype (n = 37) were the mass without microcalcifications, spiculated margins, shadowing posterior features, and low vascularity (all P < 0.05). The predictive factors of the triple-negative subtype (n = 31) were the mass without microcalcifications, oval/round shape, circumscribed margins, enhancement of posterior features, and rim enhancement (MRI) (all P < 0.005). The predictive factors of the human-epidermal-growth-factor-receptor-2-enriched subtype (n = 26) were the only microcalcifications, microlobulated margins, and combined posterior feature (all P < 0.05).

CONCLUSION

Compared with the general population of breast cancer, this young female population presents a different molecular phenotype distribution. Some imaging features of breast cancer in young women ≤30 years old can be used to predict certain tumor molecular subtypes.

Defining clinicopathological and radiological features of breast cancer in women under the age of 35: an epidemiological study

INTRODUCTION

Breast cancer is the most commonly diagnosed female cancer. Diagnosis in younger women (under 35 years) is different to their older counterparts, and mammography is not considered as sensitive in this cohort. Consequentially, younger patients may present later with more advanced disease.

METHODS

This is a retrospective analysis of a prospectively updated database containing consecutive patients who presented to the symptomatic breast unit of Galway University Hospital between 2009 and 2015. Patient clinicopathologic factors, clinical examination features, diagnostic radiological modalities and Bi-RADS score were all assessed. Data was analysed using Statistical Package for the Social Sciences version 25.

RESULTS

One thousand eight hundred thirty-six patients were diagnosed with breast cancer, and of these, 51 (2.8%) patients were < 35 years. Invasive ductal carcinoma made up 90% of diagnosis, and 42% had an associated ductal carcinoma in situ. Fifty-four percent were high-grade tumours and 52% presented with stage III disease or greater. The main radiological tool used was ultrasound, which had a sensitivity of 87.50% (95% confidence interval [CI] 74.75 to 95.27%). Mammogram sensitivity was 86.84% (95% CI 71.91 to 95.59%). Magnetic resonance imaging was used in 29% of cases, with a sensitivity of 100.00% (95% CI 78.20 to 100.00%).

CONCLUSION

Females under 35 tend to be diagnosed with aggressive, advanced stage tumours. Ultrasound remains the radiological test of choice, although diagnosis using mammography demonstrated a relatively high sensitivity compared with previous reports. This study emphasises the varying epidemiology of breast cancer in younger patients and the potential role of mammography in making radiological diagnosis in those who are symptomatic.