J Korean Soc Radiol.  2013 Jun;68(6):489-498. 10.3348/jksr.2013.68.6.489.

Comparison of Radiologic Features of Triple-Negative and Estrogen Receptor/Progesteron Receptor Positive Breast Cancer

• Kim YJ
• Kim K
• Kim DH
• Cho YJ
• Hwang CM
• Seo JY
• Kim JS
• Yoon DS
• Kim GS

• KMID: 2002901
• DOI: http://doi.org/10.3348/jksr.2013.68.6.489

Abstract

PURPOSE
To retrospectively investigate the imaging [mammographic, ultrasonographic (US), magnetic resonance (MR) imaging] features and standardized uptake values (SUV) in positron emission tomography (PET)/computed tomography (CT) of triple-negative breast cancers (TNBC) and to compare them with breast cancers that are either estrogen receptor (ER) positive or progesteron receptor (PR) positive.
MATERIALS AND METHODS
155 breast cancers cases were identified in 134 women (mean age, 51 years; range, 31-86 years). Surgically confirmed TNBC (n = 27) and ER-positive/PR-positive breast cancers (n = 81) were included among them. Cancers were investigated with mammography (n = 81), US (n = 106), MR imaging (n = 34) and PET-CT (n = 59). Mammographic findings are identified by detection of characteristic masses and microcalcifications. US findings included tumor size, margin, tumor shape, calcification and posterior shadowing. MR findings included tumor size, shape, margin, internal enhancement, intratumoral signal intensity and kinetics. Peak SUVs (p-SUV) of breast cancers were evaluated in PET/CT. These findings were compared with TNBC and ER/PR positive groups.
RESULTS
Mammographic findings had no significant association with the TNBC. High pathological grade (p < 0.05), larger than 2 cm in size, well-marginal mass, and round or oval-shaped (p < 0.05) is US were significantly associated with TNBC. In MR imaging, round mass shape (p < 0.05), well-circumscribed mass margin (p < 0.05), rim enhancement (p < 0.05), were significantly associated with TNBC. The peak SUV of TNBC tend to be higher than that of ER-positive/PR-positive breast cancer (7.95 +/- 5.50 vs. 4.91 +/- 3.00, p < 0.05).
CONCLUSION
TNBC tend to have high pathological grade, are of a large, round and smooth mass with rim enhancement on MR and US. In addition to above features, PET-CT with SUV estimation can improve the accuracy of test through the evaluation of TNBC.

MeSH Terms

Breast
Breast Neoplasms
Estrogens
Female
Humans
Kinetics
Magnetic Resonance Spectroscopy
Mammography
Positron-Emission Tomography
Retrospective Studies
Shadowing (Histology)
Estrogens

Figure

• 

  Fig. 1 35-year-old female with triple negative breast cancer. A. Breast ultrasonography shows a 2.1 cm, microlobulated lobular hypoechoic mass in the left upper inner quadrant. B. Gd-enhanced dynamic breast MRI shows thick walled enhancing mass in the left upper inner quadrant, which is iso-signal intensity on T2 weighted axial image. C. PET-CT shows markedly hypermetabolic lesion in the left upper inner quadrant (peak SUV = 15.5). D. Photomicrograph shows high grade invasive ductal carcinoma (H-E stain, × 200). Immunostain shows ER (-), PR (-) and HER-2 (-). Note.-ER = estrogen receptor, HER-2 = human epidermal growth factor receptor-2, PET-CT = positron emission tomography-CT, PR = progesteron receptor, SUV = standardized uptake values

• 

  Fig. 2 65-year-old female with triple negative breast cancer. A. Mammography shows a 2.5 cm lobular hyperdese mass with central calcification in the right lower mid portion. B. Breast ultrasonography shows a 2.5 cm lobular hypoechoic mass with central echogenic calcification in the right lower mid portion. C. PET-CT shows markedly hypermetabolic lesion in the right lower mid portion (peak SUV = 13.9). D. Photomicrography shows high grade metaplastic carcinoma. Osteoclast-like giant cell is seen (arrow) (H-E stain, × 100). Immunostain shows ER (-), PR (-) and HER-2 (-). Note.-ER = estrogen receptor, HER-2 = human epidermal growth factor receptor-2, PET-CT = positron emission tomography-CT, PR = progesteron receptor, SUV = standardized uptake values

• 

  Fig. 3 45-year-old female with ER positive/PR positive breast cancer. A. Mammography shows a 2.0 cm spiculated hyperdese mass in the left mid inner portion. B. Breast ultrasonography shows a 2.0 cm spiculated irregular shape hypoechoic mass in the left mid inner portion. C. Gd-enhanced dynamic breast MRI shows homogeneously enhanced spiculated mass in the left mid inner portion. D. PET-CT shows slightly hypermetabolic lesion in the left mid inner portion (peak SUV = 2.1). E. Photomicrography shows low grade invasive ductal carcinoma (H-E stain, × 200). Immunostain shows ER (+), PR (+) and HER-2 (+). Note.-ER = estrogen receptor, HER-2 = human epidermal growth factor receptor-2, PET-CT = positron emission tomography-CT, PR = progesteron receptor, SUV = standardized uptake values

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