Are There Specific Ultrasound Characteristics That Allow Us To Identify Triple Negative Breast Cancer

PURPOSE: Triple-negative breast cancer (TNBC) is defined as a tumor that has lost expression of Estrogen (E), Progesterone (P) and HER 2 receptors. They represent 12 to 17% of all diagnosed cancers, are more aggressive and have poor prognosis. Only few publications have been made about their ultrasound (US) characteristics. The aim of this work is to analyze TNBC on US imaging and assess if they have any characteristic pattern that allows detection. METHOD AND MATERIALS: US findings for 55 patients (mean age, 52 years; range, 26-80 years) with a confirmed TNBC (<1% E and PR, Cerb2-, 1+ or 2+ and FISH -) were reviewed retrospectively from 2003 to 2012. Seven breast image specialists performed the exams (5-12 and 17 MHz probes, color Doppler). Noted features included: mass or non-mass, echogenicity, margins, acoustic effect, orientation, location, vascularization and BI-RADS US category. An Excel database was created adding other clinical variables (size, palpability, focality, nodal status, histology, age, history of breast cancer). Qualitative variables were described by percentage distribution, mean and SD. RESULTS: Ninety-eight percentage of the TNBC present as mass (93% solid, 7% mixed), unifocal (52/55), without calcifications (51/55). The most frequent US features were: marked hypoechoic (68%), posterior location in the gland (65%), vascularization absent or only in the periphery (70%). Five % of the TNBC were interpreted as probably benign (BI-RADS 3), 68% had high histologic degree, size ranged from 8 to 100 mm (median: 18 mm), 25% of patients were less than 40 years of age and 34% had axillar metastases at time of diagnosis. of the all TNBC 47% have a common and characteristic US pattern. CONCLUSION: in face of a solitary, non calcified breast mass on US, we may suspect the presence of TNBC if this lesion is located in the posterior third of the gland, is markedly hypoechoic, cystic- like, poorly vascularized on color Doppler (or only in the periphery but with no central vessels), specially in younger patients. The 47% of the triple negative breast cancer presents a characteristic US pattern that allows us to identify this entity, which may improve treatment planning and prognosis.