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Triple-negative Breast Cancer

Posted Jul 31, 2011 Updated Apr 10, 2023
By Hiroko Kawashima MD , Masafumi Inokuchi MD , Hiroyuki Furukawa MD , Seiko Kitamura MD
10 min read

Rationale and Objectives

The purpose of the present study was to evaluate the imaging findings of triple-negative breast cancer patients receiving neoadjuvant chemotherapy (NAC) and to investigate whether the findings are different between responders and nonresponders, enabling us to predict the final patient response.

Materials and Methods

The subjects included 22 women ages 35–73 years (mean, 50.4 years) with 23 triple-negative breast cancers who underwent NAC. In all cases, a mammography, ultrasound, and magnetic resonance imaging (MRI) were performed a total of three times: before NAC, after the first half of NAC, and after NAC. The mass shape, mass margin, presence of clear intratumoral necrosis, and presence of intratumoral calcification were analyzed. The presence of clear intratumoral necrosis was evaluated on the MRI. If there was a very high signal intensity (similar to that of water) in the tumor on the fat-suppressed T2-weighted MRI scans, we judged it to be clear intratumoral necrosis.

Results

An irregularly shaped mass ( P = .018) and the presence of clear intratumoral necrosis ( P = .044) were significantly associated with NAC nonresponse in triple-negative breast cancer patients. The mass margin and the presence of intratumoral calcification were not related to the effects after NAC.

Conclusions

In cases of triple-negative breast cancer involving clear intratumoral necrosis with an irregular mass shape, it is predicted that the effects of neoadjuvant chemotherapy will likely be poor, and therefore, the presence of such image findings may be useful for determining the optimal application of neoadjuvant chemotherapy.

Breast cancer is comparatively sensitive to chemotherapy. In addition, hormone therapy is also effective for hormone receptor–positive breast cancers. Therefore, a multidisciplinary approach, which is directed both to the locoregional control (surgery and radiation therapy) and to the destruction of distant micrometastases (chemotherapy and hormone therapy) has become the main strategy in the treatment of breast cancer. The indication for chemotherapy and hormone therapy is generally decided according to the risk category in the International Consensus Conference on Primary Treatment of Breast Cancer . Triple-negative breast cancers, which are negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), are usually resistant tochemotherapy and endocrine therapy, and patients with these tumors have a poor prognosis . However, we are able to clinically identify a triple-negative breast cancer that shows a good response to chemotherapy.

Neoadjuvant chemotherapy (NAC) has been the standard treatment for locally advanced breast cancer. NAC is mainly designed to reduce tumor size, thereby permitting breast-conserving surgery . Other advantages for NAC are that systemic therapy may be initiated earlier and enables the evaluation of a patient’s response to chemotherapy . Conversely, a NAC-related disadvantage is the delay in surgical treatment in patients who do not respond to chemotherapy. If we can predict the final chemotherapeutic response during earlier courses of NAC, an earlier and optimized treatment regimen is possible, thereby improving the patient prognosis .

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Materials and methods

Patients and Treatment

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Table 1

Patient Population

No Age TNM Histological Type Chemotherapy Maximum Diameter (mm) Before NAC (MRI) Maximum Diameter (mm) After NAC (Pathology) Overall Response to NAC 1 56 T4aN1M0 IDC EC4DOC2EC2 75 75 SD 2 50 T2N0M1 IDC FEC6 25 18 SD 3 44 T2N0M0 IDC FEC4DOC4 26 (-) CR 4 44 T1bN0M0 IDC FEC4DOC4 6 1 Near CR 5 36 T2N0M0 IDC FEC4DOC4 40 (-) CR 6 60 T2N0M0 IDC FEC4DOC4 40 DCIS only Near CR 7 52 T3N1M0 IDC FEC4DOC4 60 22 PD (new lesion) 8 43 T4cN3cM0 IDC FEC4 100 110 SD 9 44 T2N0M0 Pleomorphic carcinoma FEC4DOC4 40 32 SD 10 55 T2N0M0 IDC FEC4DOC4 38 35 SD 11 61 T2N1M0 IDC FEC4DOC4 26 (-) CR 12 35 T1cN1M0 IDC FEC4DOC4 18 15 SD 13 41 T3N3bM0 IDC FEC4DOC2 85 110 ∗ (MRI) PD 14 45 T2N1M0 IDC FEC4DOC4 25 40 PD 15 61 T2N1M0 IDC FEC4DOC4 25 9 PR 16 73 T4dN1M0 IDC FEC4DOC4 50 41 SD 17 42 T2N0M0 IDC FEC4DOC4 22 (-) CR 18 54 T2N0M0 IDC FEC4DOC4 34 20 PR 19 50 T2N0M0 IDC FEC4DOC4 22 5 PR 20 47 T2N0M0 IDC FEC4DOC2 35 18 SD (regrowth) 21 65 T2N0M0 IDC FEC4DOC4 21 2 near CR 22 48 T2N0M0 IDC FEC4DOC4 21 2 near CR 23 54 T2N0M0 IDC FEC4DOC4 22 4 PR

(-), pathological complete response; DCIS, ductal carcinoma in situ; IDC, invasive ductal carcinoma; NAC, neoadjuvant chemotherapy.

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Imaging Methods

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Image Analysis

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Histopathology

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Therapeutic Response Evaluation

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Statistical Analysis

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Results

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Table 2

Comparison of Imaging Findings Between Good Responders and Nonresponders

Imaging Finding Good Responders ( n = 8) Nonresponders ( n = 11)P Value Mass shape Round, oval, lobulated 8 5 .018 Irregular 0 6 Mass margin Smooth 5 5 NS Irregular 3 6 Clear intratumoral necrosis Presence 0 5 .044 Absence 8 6 Intratumoral calcification on mammogram Presence 2 3 NS Absence 6 8

NS, not significant.

Figure 1, Triple-negative breast cancer of right breast in 50-year-old woman. (a) Before neoadjuvant chemotherapy (NAC), ultrasonogram shows an irregularly shaped mass. (b) After the first half of NAC, there is a reduction in tumor size. (c) After NAC, there is an increase in tumor size.

Figure 2, Triple-negative breast cancer of left breast in 56-year-old woman. (a) Before neoadjuvant chemotherapy (NAC), coronal T1-weighted magnetic resonance image with fat suppression shows a peripherally enhancing mass with a large area of intratumoral necrosis. (b) After the first half of NAC, there is a slight reduction in tumor size. (c) After NAC, there is a clear increase in tumor size.

Figure 3, Triple-negative breast cancer of left breast in 36-year-old woman. (a) Prior to NAC, coronal T1-weighted MR image with fat suppression shows a lobulated enhancing mass. (b) After the first half of NAC, there is no longer recognizable tumor. (c) Following NAC, MRI still fails to show tumor.

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Discussion

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Academic Radiology, Volume 18, Issue 8
Journals General Radiology
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