A retrospective review of triple-negative breast cancer cases: are there common features in the clinical presentation, imaging and risk factors?

Introduction

Triple-negative breast cancer (TNBC) cases comprise approximately 15% of newly diagnosed breast cancers and are associated with poor prognosis and limited treatment options. In this retrospective study from South Wales, 81 patients with breast cancer found to be ER, PR and HER2 negative were reviewed to determine whether there are common imaging and pathological findings.

Methods

Patients identified from pathological databases at two hospitals included symptomatic and screening cases. Clinical records were reviewed to determine age at diagnosis, family history and clinical findings; pathological reports to identify size, grade, type and nodal status; and imaging studies to determine breast density, lesion type, classification and size.

Results

Eighty per cent of patients were aged over 50 years (range 50 to 89 years). Nineteen per cent reported a family history. Eighty-nine per cent were grade 3 tumours, 89% were ductal type of which 30% had associated DCIS. The majority were large tumours (78% over 20 mm). Fifty-two per cent were node positive (20% had more than four nodes positive). Thirty-nine per cent had associated vascular invasion. Calcification was a dominant mammographic feature (37%), 28% had well-defined masses.

Conclusions

Previous studies have found well-defined masses to be a dominant imaging feature but this study has found malignant calcification to be more common. The tumours were mainly large and frequently associated with vascular invasion, possibly contributing to the poor prognosis despite being node negative in nearly one-half of the cases. There appears to be an association with family history and to be common in the over 50s, contrary to current thinking. A national prospectively collected database TNBC could aid understanding of this group.