Breast ImagingE3055. Breast MRI in Young Women with Breast Cancer: Tumor Imaging and Phenotypic features
Adeniji-Sofoluwe A1,2, Sheth D1, Wang S1, Olopade O1, Abe H.1 1. University of Chicago, Chicago, United States ; 2. University of Ibadan, Ibadan, Nigeria
Address correspondence to A. Adeniji-sofoluwe (firstname.lastname@example.org)
Objective: Breast cancer is the leading female malignancy in the world. Breast cancer in young women tends to show a more aggressive biological behavior with larger tumors, higher-grade of disease, hormone receptor (HR) negativity and lymph node positivity, which may contribute to poorer disease outcomes. Few studies focus on the breast Magnetic Resonance Imaging (MRI) findings in these patients. The essence of this study is to present classic breast MRI findings in young women with breast cancer and correlate that with tumor pathology, tumor grade, HR status.
Materials and Methods: A descriptive and retrospective HIPAA compliant study was carried out at the department of Radiology, University of Chicago Hospital, Illinois. Records of 55 women (40 years of age and younger) diagnosed with breast cancer from January 2012 - August 2016 were included in the study. Breast MRIs were performed on 1.5 and 3.0 Tesla strength magnets (Philips) and interpreted by four radiologists with a total of 29 years breast imaging experience. Bio-demographic characteristics of the women were extracted from the patients’ records. Reviews of the breast MRI studies were performed with attention to clinical history, tumor imaging features and tumor phenotypic features.
Results: Fifty–five women ranging in age from 22-37 years (mean 31.8 years ± SD 3.1) were evaluated. Majority of the women were Caucasian (33/55, 60%), while African American women accounted for 32.7% (18/55). Most common breast density patterns were extremely dense breasts (45/55, 45.5%) and heterogeneously dense breasts (20/55, 36.4%), respectively. Most common background parenchymal enhancement pattern was moderate (36.4%). Unilateral unifocal cancers were the most common 28/55(50.9%) while bilateral multifocal were the least 3/55(5.5%). Median tumor size was 2.6 cm (range of 0.9 to 13.0 cm). Cancers were mostly irregular in shape 31/55 (56.4%) with irregular margins 32/55(58.2%). Most common enhancement pattern was heterogeneous 38/55 (69.1%) mass, non-mass enhancement (NME) accounted for 23/55(41.8%) while a combination of the two were demonstrated in 16/55(29.1%) patients. Invasive ductal carcinoma with ductal carcinoma–in-situ was the most prevalent histological type in 34/55 (61.8%) with grade III preponderance. Estrogen HR+ (72.7%) and progesterone HR+ (54.6%) were predominant. Human Epidermal growth factor receptor 2 (Her-2) was negative in 67.3%. Proliferative index by the expression of nuclear antigen Ki-67 was performed in 35 patients, but found unfavorable in 25/35 (71.4%). Metastatic axillary lymph nodes were found in 41.8% (23/55) of cases.
Conclusion: Most common breast MRI pattern in this patient population includes unilateral unifocal lesions with irregular shape, heterogeneous enhancement and high grade on pathology while the most common phenotypic features include Her-2 negativity with unfavorable proliferative index and disease positive axillary lymph nodes. These results place an importance in carefully assessing the imaging features of young females with breast cancer, as these may portend a more aggressive biological behavior.