Clinicopathological and Imaging Features of Breast Cancer in Korean Women under 40 Years of Age

Junwoo Kim; Mijung Jang; Sun Mi Kim; Bo La Yun; Jong Yoon Lee; Eun-Kyu Kim; Eunyoung Kang; So Yeon Park

doi:10.3348/jksr.2017.76.6.375

Journal List > J Korean Soc Radiol > v.76(6) > 1087806

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Jang, Kim, Yun, Lee, Kim, Kang, and Park: Clinicopathological and Imaging Features of Breast Cancer in Korean Women under 40 Years of Age

Original Article

J Korean Soc Radiol 2017;76(6):375-385.

Published online: 7 January 2017

DOI: https://doi.org/10.3348/jksr.2017.76.6.375

Clinicopathological and Imaging Features of Breast Cancer in Korean Women under 40 Years of Age

Junwoo Kim¹, Mijung Jang^1,^∗, Sun Mi Kim¹, Bo La Yun¹, Jong Yoon Lee¹, Eun-Kyu Kim², Eunyoung Kang², So Yeon Park³

¹Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea

²Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

³Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea

^∗ Corresponding author: Mijung Jang, MD Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel. 82-31-787-7622 Fax. 82-31-787-7614 E-mail: mjjang74@gmail.com

Received 4 August 201610 November 2016 Accepted 19 December 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the clinicopathological and imaging features of mammography, ultrasonography, and magnetic resonance imaging (MRI) for breast cancer in Korean women under 40 years of age according to molecular subtypes.

Materials and Methods

We included 183 breast cancers in 176 consecutive women under 40 years old who had been diagnosed with breast cancer between January 2012 and November 2014. The patients’ clinical and pathologic records were available as electronic medical records. A retrospective review of the preoperative imaging studies was performed with 177 mammographies, 183 ultrasonographies, and 178 MRIs.

Results

Eighty-six percent (158/183) of lesions were symptomatic, with masses (147/183) as the most common presentation. Eighty percent (22/25) of the asymp-tomatic lesions were diagnosed via screening ultrasonography. The luminal A subtype was the most common (n = 79, 43%), human epidermal growth factor receptor 2-en-riched subtype showed indistinct margins on mammography (p = 0.006), the triple negative subtype depicted a posterior enhancement on ultrasonography (p < 0.001) and rim enhancement on MRI (p < 0.001).

Conclusion

Breast cancers in Korean women under 40 years of age are commonly presented with a palpable mass, and luminal A is the most common molecular subtype. In our study, the imaging and pathologic characteristics of breast cancer in younger women were similar to those previously reported for older patients.

Index terms:

Index terms

Breast Cancer, Mammography, Ultrasonography, Magnetic Resonance Imaging, Young Adult

REFERENCES

1. Jemal A, Clegg LX, Ward E, Ries LA, Wu X, Jamison PM, et al. Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer. 2004; 101:3–27.

2. Ko SS. Korean Breast Cancer Society. Chronological chang-ing patterns of clinical characteristics of Korean breast cancer patients during 10 years (1996-2006) using nationwide breast cancer registration on-line program: biannual up-date. J Surg Oncol. 2008; 98:318–323.

3. Ahn SH, Son BH, Kim SW, Kim SI, Jeong J, Ko SS, et al. Poor outcome of hormone receptor-positive breast cancer at very young age is due to tamoxifen resistance: nationwide survival data in Korea–a report from the Korean Breast Cancer Society. J Clin Oncol. 2007; 25:2360–2368.

4. Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H. Breast cancer in young women: poor survival despite intensive treatment. PLoS One. 2009; 4:e7695.

5. Prevalence and penetrance of BRCA1 and BRCA2 mutations in a population-based series of breast cancer cases. Anglian Breast Cancer Study Group. Br J Cancer. 2000; 83:1301–1308.

6. Zhou P, Recht A. Young age and outcome for women with early-stage invasive breast carcinoma. Cancer. 2004; 101:1264–1274.

7. Neal RD, Allgar VL. Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the “National Survey of NHS Patients: Cancer”. Br J Cancer. 2005; 92:1971–1975.

8. Partridge AH, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, et al. The effect of age on delay in diagnosis and stage of breast cancer. Oncologist. 2012; 17:775–782.

9. Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, et al. Breast cancer presentation and diagnos-tic delays in young women. Cancer. 2014; 120:20–25.

10. Keegan TH, DeRouen MC, Press DJ, Kurian AW, Clarke CA. Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res. 2012; 14:R55.

11. Park YH, Lee SJ, Jung HA, Kim SM, Kim MJ, Kil WH, et al. Prevalence and clinical outcomes of young breast cancer (YBC) patients according to intrinsic breast cancer subtypes: single institutional experience in Korea. Breast. 2015; 24:213–217.

12. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and proges-terone receptors in breast cancer. J Clin Oncol. 2010; 28:2784–2795.

13. Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, et al. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst. 2009; 101:736–750.

14. American College of Radiology. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston: American College of Radiology;2013.

15. Collins LC, Marotti JD, Gelber S, Cole K, Ruddy K, Kereako-glow S, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat. 2012; 131:1061–1066.

16. Tang J, Wu CC, Xie ZM, Luo RZ, Yang MT. Comparison of clinical features and treatment outcome of breast cancers in young and elderly chinese patients. Breast Care (Basel). 2011; 6:435–440.

17. Kim EK, Noh WC, Han W, Noh DY. Prognostic significance of young age (<35 years) by subtype based on ER, PR, and HER2 status in breast cancer: a nationwide registry-based study. World J Surg. 2011; 35:1244–1253.

18. Bassett LW, Ysrael M, Gold RH, Ysrael C. Usefulness of mammography and sonography in women less than 35 years of age. Radiology. 1991; 180:831–835.

19. Taneja S, Evans AJ, Rakha EA, Green AR, Ball G, Ellis IO. The mammographic correlations of a new immunohistochemical classification of invasive breast cancer. Clin Radiol. 2008; 63:1228–1235.

20. Bullier B, MacGrogan G, Bonnefoi H, Hurtevent-Labrot G, Lhomme E, Brouste V, et al. Imaging features of sporadic breast cancer in women under 40 years old: 97 cases. Eur Radiol. 2013; 23:3237–3245.

21. Lehman CD, Lee CI, Loving VA, Portillo MS, Peacock S, DeMartini WB. Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 2012; 199:1169–1177.

22. Au-Yong IT, Evans AJ, Taneja S, Rakha EA, Green AR, Paish C, et al. Sonographic correlations with the new molecular classification of invasive breast cancer. Eur Radiol. 2009; 19:2342–2348.

23. Kojima Y, Tsunoda H. Mammography and ultrasound features of triple-negative breast cancer. Breast Cancer. 2011; 18:146–151.

24. Kim JY, Lee SH, Lee JW, Kim S, Choo KS. Magnetic resonance imaging characteristics of invasive breast cancer in women aged less than 35 years. Acta Radiol. 2015; 56:924–932.

25. Uematsu T, Kasami M, Yuen S. Triple-negative breast cancer: correlation between MR imaging and pathologic findings. Radiology. 2009; 250:638–647.

26. Thapa B, Singh Y, Sayami P, Shrestha UK, Sapkota R, Sayami G. Breast cancer in young women from a low risk popula-tion in Nepal. Asian Pac J Cancer Prev. 2013; 14:5095–5099.

Fig. 1.

Luminal A type breast cancer of 37-year-old woman. A. Right mediolateral oblique mammography shows 2 cm-sized isodense mass with irregular shape and indistinct margin (arrow) on the right lower breast. B. Ultrasonography shows 2.5 cm-sized hypoechoic mass with irregular shape and indistinct margin (arrows) in the right 6 o'clock direction. C. Axial contrast-enhanced T1-weighted MR image with fat suppression shows a 2.5 cm-sized heterogeneously enhancing mass with an irregular shape and margin (arrows).

Fig. 2.

Triple negative type breast cancer of 37-year-old woman. A. Right craniocaudal mammography shows 3 cm-sized hyperdense mass with an irregular shape and obscured margin (arrows) on the right outer breast. B. Ultrasonography shows 3.4 cm-sized hypoechoic mass with an oval shape and circumscribed margin with a posterior enhancement (arrows) in the right 9 o'clock direction. C. Axial contrast-enhanced T1-weighted MR image with fat suppression shows a 3.5 cm-sized mass with an oval shape, circumscribed margin and rim enhancement (arrows) in the right outer center breast.

Fig. 3.

Human epidermal growth factor receptor-2 enriched type breast cancer of 38-year-old woman. A. Left mediolateral oblique mammography shows a 9-cm area of segmental fine linear microcalcifications (arrows). B. Ultrasonography shows more than 5 cm-sized heterogeneous echoic mass with an irregular shape and calcifications (arrows) in the left 5 o'clock direction. C. Axial contrast-enhanced T1-weighted MR image with fat suppression shows a 7-cm area of non-mass enhancement with segmental distribution and clustered ring internal enhancement pattern (arrows) on the left lower outer breast.

Table 1.

Clinicopathologic Data for 183 Breast Cancers in 176 Patients

	n (%)
Clinical symptom
Negative	25 (14)
Lump	147 (80)
Discharge	8 (4)
Lump with discharge	3 (2)
Histology
IDC	23 (12)
IDC + DCIS	124 (68)
DCIS	23 (13)
ILC	2 (1)
Others	11 (6)
Histologic grade
I	23 (13)
II	87 (47)
III	73 (40)
Molecular subtype
Luminal A	79 (43)
Luminal B	42 (23)
HER2 +	19 (10)
Triple negative	43 (24)
Prior breast biopsy for breast cancer^∗
No	133 (80)
Yes	33 (20)
Family history of breast cancer^∗
No	138 (81)
Yes	32 (19)
Distant metastasis
No	179 (98)
Yes	4 (2)

^∗ Non-responders were excluded in these categories.

DCIS = ductal carcinoma in situ, HER2 = human epidermal growth factor receptor 2, IDC = invasive ductal carcinoma, ILC = invasive lobular carcinoma

Table 2.

Evaluation of Mammographic Features of Breast Cancer under 40 Years Old

Characteristics	All (n = 177)	Luminal A (n = 76)	Luminal B (n = 40)	HER2 (n = 19)	TN (n = 42)	p-Value^∗
Finding (%)						0.019
Negative	14 (8)	9 (12)	2 (5)	1 (5)	2 (5)
Mass (± calcification)	116 (66)	42 (55)	26 (65)	13 (68)	35 (83)
Calcification only	32 (18)	14 (18)	11 (28)	5 (26)	2 (5)
Others^†	15 (8)	11 (14)	1 (3)	0 (0)	3 (7)
Mass (n = 116)
Shape (%)						0.668
Oval/round	13 (11)	6 (14)	3 (12)	0 (0)	4 (11)
Irregular	103 (89)	36 (86)	23 (88)	13 (100)	31 (89)
Margin (%)						0.006
Circumscribed	6 (4)	3 (7)	0 (0)	0 (0)	3 (9)
Obscured	32 (28)	8 (19)	7 (27)	1 (8)	16 (46)
Microlobulated	3 (3)	2 (5)	1 (4)	0 (0)	0 (0)
Indistinct	52 (45)	15 (36)	12 (46)	11 (85)	14 (40)
Spiculated	23 (20)	14 (33)	6 (23)	1 (8)	2 (6)
Density (%)						0.075
High	75 (65)	21 (50)	18 (69)	11 (85)	25 (71)
Equal	41 (35)	21 (50)	8 (31)	2 (15)	10 (29)
Low	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Calcification (n = 81)
Shape (%)						0.399
Round	7 (9)	3 (10)	2 (8)	1 (8)	1 (8)
Amorphous	16 (20)	8 (27)	3 (12)	2 (15)	3 (31)
Coarse heterogeneous	8 (10)	2 (7)	1 (4)	1 (8)	3 (23)
Fine pleomorphic	28 (35)	10 (33)	11 (44)	3 (23)	4 (31)
Fine linear branching	22 (27)	7 (23)	8 (32)	6 (46)	1 (8)
Distribution (%)						0.143
Grouped	40 (49)	12 (40)	14 (56)	5 (38)	9 (69)
Linear	8 (10)	2 (7)	0 (0)	3 (23)	3 (23)
Segmental	13 (16)	5 (17)	6 (24)	2 (15)	0 (0)
Regional	14 (17)	8 (27)	3 (12)	2 (15)	1 (8)
Diffuse	6 (7)	3 (10)	2 (8)	1 (8)	0 (0)

^∗ The p-value was calculated with Fisher's exact test or Pearson's chi square test.

^† This category includes asymmetry and architectural distortion.

HER2 = human epidermal growth factor receptor 2, TN = triple negative

Table 3.

Evaluation of Ultrasonography Features of Breast Cancer under 40 Years Old

Characteristics	All (n = 183)	Luminal A (n = 79)	Luminal B (n = 42)	HER2 (n = 19)	TN (n = 43)	p-Value^∗
Finding (%)						0.211
Mass (± calcification)	179 (98)	78 (99)	40 (95)	18 (95)	43 (100)
Negative	4 (2)	1 (1)	2 (5)	1 (5)	0 (0)
Mass (± calcification) (n = 179)
Shape (%)						0.481
Oval/round	25 (14)	8 (10)	8 (20)	2 (11)	7 (16)
Irregular	154 (86)	70 (90)	32 (80)	16 (89)	36 (84)
Margin (%)						0.478
Circumscribed	24 (13)	11 (14)	3 (8)	1 (6)	9 (21)
Indistinct	71 (40)	30 (38)	18 (45)	9 (50)	14 (33)
Angular	42 (23)	19 (24)	9 (23)	3 (17)	11 (26)
Microlobulated	33 (18)	12 (15)	7 (18)	5 (28)	9 (21)
Spiculated	9 (5)	6 (8)	3 (8)	0 (0)	0 (0)
Orientation (%)						0.095
Parallel	146 (82)	60 (77)	34 (85)	18 (100)	34 (79)
Non-parallel	33 (18)	18 (23)	6 (15)	0 (0)	9 (21)
Echo pattern (%)						0.079
Anechoic	1 (1)	1 (1)	0 (0)	0 (0)	0 (0)
Hyperechoic	2 (1)	2 (3)	0 (0)	0 (0)	0 (0)
Complex cystic and solid	6 (3)	3 (4)	0 (0)	0 (0)	3 (7)
Hypoechoic	93 (52)	41 (53)	21 (53)	6 (33)	25 (58)
Isoechoic	23 (13)	15 (19)	4 (10)	4 (22)	0 (0)
Heterogeneous	54 (30)	16 (21)	15 (38)	8 (44)	15 (35)
Posterior feature (%)						< 0.001
Non	114 (64)	56 (72)	33 (83)	7 (39)	18 (42)
Enhancement	46 (26)	14 (18)	5 (13)	6 (33)	21 (49)
Shadowing	13 (7)	6 (8)	1 (3)	3 (17)	3 (7)
Combined	6 (3)	2 (3)	1 (3)	2 (11)	1 (2)

^∗ The p-value was calculated with Fisher's exact test or Pearson's chi square test.

HER2 = human epidermal growth factor receptor 2, TN = triple negative

Table 4.

Evaluation of Magnetic Resonance Imaging Features of Breast Cancer under 40 Years Old

Characteristics	All (n = 178)	Luminal A (n = 76)	Luminal B (n = 41)	HER2 (n = 18)	TN (n = 43)	p-Value^∗
Finding (%)						0.086
Mass	143 (80)	58 (76)	33 (80)	12 (67)	40 (93)
NME	32 (18)	15 (20)	8 (20)	6 (33)	3 (7)
Focus	3 (2)	3 (4)	0 (0)	0 (0)	0 (0)
Mass (n = 143)
Shape (%)						0.618
Oval/round	24 (17)	9 (16)	8 (24)	1 (8)	6 (15)
Irregular	119 (83)	49 (84)	25 (76)	11 (92)	34 (85)
Margin (%)						0.179
Circumscribed	41 (29)	17 (29)	10 (30)	2 (17)	12 (30)
Irregular	80 (56)	27 (47)	18 (55)	9 (75)	26 (65)
Spiculated	22 (15)	14 (24)	5 (15)	1 (8)	2 (5)
Internal enhancement (%)						< 0.001
Homogenous	37 (26)	20 (34)	11 (33)	2 (17)	4 (10)
Heterogeneous	63 (44)	31 (53)	13 (39)	5 (42)	14 (35)
Rim	41 (29)	7 (12)	9 (27)	3 (25)	22 (55)
Dark internal septation	2 (1)	0 (0)	0 (0)	2 (17)	0 (0)
NME (n = 32)
Distribution (%)						0.587
Focal	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Linear	1 (3)	1 (7)	0 (0)	0 (0)	0 (0)
Segmental	14 (44)	6 (40)	4 (50)	4 (67)	0 (0)
Regional	7 (22)	4 (27)	2 (25)	0 (0)	1 (33)
Multiple regional	3 (9)	2 (13)	0 (0)	1 (17)	0 (0)
Diffuse	7 (22)	2 (13)	2 (25)	1 (17)	2 (67)
Internal enhancement (%)						0.578
Homogenous	6 (19)	3 (20)	3 (38)	0 (0)	0 (0)
Heterogeneous	14 (43)	7 (47)	3 (38)	3 (50)	1 (33)
Clumped	8 (25)	4 (27)	1 (13)	1 (17)	2 (67)
Clustered ring	4 (13)	1 (7)	1 (13)	2 (33)	0 (0)

^∗ The p-value was calculated with Fisher's exact test or Pearson's chi square test.

HER2 = human epidermal growth factor receptor 2, NME = non-mass enhancement, TN = triple negative

TOOLS

Similar articles