Breast Cancer in Women Younger than 35-Years-Old: Correlation of MRI Findings with Clinicopathological Features and Immunohistochemical Subtypes

Sae Hyung Lee; Bong Joo Kang; Yeong Yi An

doi:10.3348/jksr.2018.79.4.196

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Lee, Kang, and An: Breast Cancer in Women Younger than 35-Years-Old: Correlation of MRI Findings with Clinicopathological Features and Immunohistochemical Subtypes

Original Article

J Korean Soc Radiol 2018;79(4):196-203.

Published online: 19 January 2018

DOI: https://doi.org/10.3348/jksr.2018.79.4.196

Breast Cancer in Women Younger than 35-Years-Old: Correlation of MRI Findings with Clinicopathological Features and Immunohistochemical Subtypes

Sae Hyung Lee, MD¹, Bong Joo Kang, MD², Yeong Yi An, MD^1,

¹Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, Suwon, Korea

²Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

^∗Corresponding author: Yeong Yi An, MD Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea. Tel. 82-31-249-8495 Fax. 82-31-247-5713 E-mail: didi97@catholic.ac.kr

Received 23 February 2018 Revised 19 May 2018 Accepted 13 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://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:

Breast cancer of young women shows poor prognosis, but the imaging findings has not been well known. We evaluated the MRI characteristics of young women.

Materials and Methods:

From January 2009 to December 2013, we included 91 patients under the age of 35 who were diagnosed histologically as breast cancer and underwent MRI. The relationship between the clinical and histopathological prognostic factors was obtained using electronic medical records and the retrospective analysis of MRI findings was statistically analyzed.

Results:

The most common imaging findings of breast mass were irregular shape (53.7%), irregular margin (53.7%), heterogeneous enhancement (53.8%), and type 3 kinetic curve pattern (57.1%). In the multivariate analysis, the rim enhancement was significantly related to the higher tissue grade (p = 0.001), estrogen receptor negative (p < 0.001), and progesterone receptor negative (p < 0.001). The irregular mass shape (p = 0.015) and type 3 kinetic curve (p = 0.002) were related to lymph node metastasis.

Conclusion:

MRI findings of breast cancer in young women (≤ 35-years-old) are not different from those of general breast cancer, but the rim enhancement, irregular mass shape and type 3 kinetic curve are related with pathologic factors of poor prognosis.

Keywords: Breast Neoplasms, Magnetic Resonance Imaging, Mammography, Ultrasonography, Young Adult

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Table 1.

Clinicopathological Data for 91 Patients in Our Study

Clinicopathological Chracteristics	n (%)
Mean age (years)	31.5
Presentation
Asymptomatic	26 (28.6)
Palpable mass	61 (67.0)
Nipple discharge	4 (4.4)
Median clinical tumor size, cm (range)	3.63 (0.5–10.5)
Type of surgery
BCS	59 (64.8)
MRM	23 (25.3)
No surgery	9 (9.9)
Histologic type
IDC, NOS	66 (72.5)
DCIS	12 (13.2)
ILC	1 (1.1)
Medullary	2 (2.2)
Metaplastic	2 (2.2)
Mucinous	5 (5.5)
Microinvasive ductal	3 (3.3)
Clinical T stage
T1/T2	51 (56.0)
T2/T3	40 (44.0)
Axillary lymph node
Negative	48 (52.7)
Positive	30 (33.0)
Unknown	13 (14.3)
Tumor grade
Grade I	15 (16.5)
Grade II	32 (35.2)
Grade III	43 (47.2)
Unknown	1 (1.1)
Phenotype
Luminal A	43 (47.3)
Luminal B	15 (16.4)
HER-2 enriched	5 (5.5)
Triple negative	22 (24.2)
Unknown	6 (6.6)

BCS = breast-conserving surgery, DCIS = Ductal carcinoma in situ, HER-2 = human epidermal growth factor receptor-2, IDC, NOS = invasive ductal carcinoma, not otherwise specified, ILC = invasive lobular carcinoma, MRM = modified radical mastectomy

Table 2.

MRI Findings in 91 Cases

Feature	n (%)
Background parenchymal enhancement
Minimal/mild	79 (86.8)
Moderate/marked	12 (13.2)
Lesion type
Mass	67 (73.6)
Non-mass	24 (26.4)
Mass shape
Oval	28 (41.8)
Round	3 (4.5)
Irregular	36 (53.7)
Mass margin
Circumscribed	22 (32.8)
Irregular	36 (53.7)
Spiculated	9 (13.5)
Mass internal enhancement
Homogeneous	3 (4.4)
Heterogeneous	36 (53.8)
Rim	28 (41.8)
Non-mass distribution
Focal	4 (16.6)
Segmental	18 (75.0)
Regional	1 (4.2)
Diffuse	1 (4.2)
Non-mass enhancement
Homogeneous	1 (4.2)
Heterogeneous	13 (54.2)
Clumped	6 (25.0)
Clustered ring	4 (16.6)
Kinetic curve
Type 1	14 (15.4)
Type 2	25 (27.4)
Type 3	52 (57.1)
BI-RADS category
C4	67 (73.6)
C5	24 (26.4)

BI-RADS = breast imaging-reporting and data system

Table 3.

The Correlation of MRI Features with Molecular Prognostic Factors of Breast Cancers in 91 Cases

	Size	LN Metastasis		ER		PR		HER-2
	Size	Negative	Positive	Negative	Positive	Negative	Positive	Negative	Positive
Lesion type
Mass	3.26 ± 2.22	29 (76.32)	25 (83.33)	22 (75.86)	40 (71.43)	26 (78.79)	36 (69.23)	49 (69.01)	13 (65.00)
Non-mass	4.67 ± 3.00	9 (23.68)	5 (16.67)	7 (24.14)	16 (28.57)	7 (21.21)	16 (30.77)	22 (30.99)	7 (35.00)
p-value	0.017	0.683		0.858		0.474		0.454
Mass shape
Oval	2.87 ± 1.83	17 (58.62)	6 (24.00)	15 (68.18)	12 (30.00)	16 (61.54)	11 (30.56)	23 (46.94)	4 (30.77)
Round	4.13 ± 3.87	2 (6.89)	1 (4.00)	1 (4.55)	2 (5.00)	1 (3.85)	2 (5.56)	3 (6.12)	0 (0.00)
Irregular	3.48 ± 2.38	10 (34.48)	18 (72.00)	6 (27.27)	26 (65.00)	9 (34.62)	23 (63.89)	23 (46.94)	9 (69.23)
p-value	0.287	0.022		0.013		0.052		0.355
Mass margin
Circumscribed	3.06 ± 2.25	11 (37.93)	6 (24.00)	12 (54.55)	9 (22.50)	13 (50.00)	8 (22.22)	18 (36.73)	3 (23.08)
Irregular	3.62 ± 2.32	16 (53.17)	14 (56.00)	10 (45.45)	24 (60.00)	12 (46.15)	22 (61.11)	26 (53.06)	8 (61.54)
Spiculated	2.27 ± 1.46	2 (6.90)	5 (20.00)	0 (0.00)	7 (17.50)	1 (3.85)	6 (16.67)	5 (10.20)	2 (15.38)
p-value	0.704	0.271		0.013		0.044		0.604
Internal enhancement of mass
Homogeneous	1.10 ± 0.70	1 (3.45)	0 (0.00)	0 (0.00)	3 (7.50)	0 (0.00)	3 (8.33)	3 (6.12)	0 (0.00)
Heterogeneous	3.38 ± 1.84	11 (37.93)	16 (64.00)	3 (13.64)	28 (70.00)	6 (23.08)	25 (69.44)	21 (42.86)	10 (76.92)
Rim	3.34 ± 2.67	17 (58.62)	9 (36.00)	19 (86.36)	9 (22.50)	20 (76.92)	8 (22.22)	25 (51.02)	3 (23.08)
p-value	0.406	0.128		< 0.001		< 0.001		0.091
Non-mass distribution
Focal	1.73 ± 0.74	3 (27.27)	0 (0.00)	1 (14.29)	3 (18.75)	1 (14.29)	3 (18.75)	0 (0.00)	4 (57.14)
Segmental	5.36 ± 2.65	8 (72.72)	4 (57.14)	5 (71.43)	12 (75.00)	5 (71.43)	12 (75.00)	18 (81.82)	2 (28.57)
Regional	1.20 ± 0.00	0 (0.00)	1 (14.29)	0 (0.00)	1 (6.25)	0 (0.00)	1 (6.25)	0 (0.00)	1 (14.29)
Diffuse	10.50 ± 0.00	0 (0.00)	2 (28.57)	1 (14.29)	0 (0.00)	1 (14.29)	0 (0.00)	4 (18.18)	0 (0.00)
p-value	0.009	0.079		0.426		0.426		< 0.001
Non-mass enhancement
Homogeneous	1.20 ± 0.00	0 (0.00)	1 (14.29)	0 (0.00)	1 (6.25)	0 (0.00)	1 (6.25)	0 (0.00)	1 (14.29)
Heterogeneous	4.26 ± 2.82	7 (63.64)	4 (57.14)	6 (85.71)	7 (43.75)	6 (85.71)	7 (43.75)	13 (59.09)	4 (57.14)
Clumped	5.67 ± 3.52	3 (27.27)	2 (28.57)	1 (14.29)	5 (31.25)	0 (0.00)	6 (37.50)	7 (31.82)	1 (14.29)
Clustered ring	5.35 ± 3.01	1 (9.09)	0 (0.00)	0 (0.00)	3 (18.75)	1 (14.29)	2 (12.50)	2 (9.09)	1 (14.29)
p-value	0.220	0.524		0.283		0.204		0.401
Kinetic curve type
Type 1	2.42 ± 2.13	8 (21.05)	1 (3.33)	2 (6.90)	12 (21.43)	2 (6.06)	12 (23.08)	9 (13.85)	5 (25.00)
Type 2	3.77 ± 2.31	13 (37.14)	4 (13.33)	6 (20.69)	17 (30.36)	9 (27.27)	14 (26.92)	21 (32.31)	2 (10.00)
Type 3	3.88 ± 2.64	17 (48.57)	25 (83.33)	21 (72.41)	27 (48.21)	22 (66.67)	26 (50.00)	35 (53.85)	13 (65.00)
p-value	0.090	0.004		0.078		0.103		0.092

ER = estrogen receptor, HER-2 = human epidermal growth factor receptor-2, LN = lymph node, PR = progesterone receptor

Table 3.

The Correlation of MRI Features with Molecular Prognostic Factors of Breast Cancers in 91 Cases (continued)

	Ki-67		Perineural Invasion		Vascular Invasion		Lymphatic Invasion		Tumor Grade
	Negative	Positive	Negative	Positive	Negative	Positive	Negative	Positive	Grade 1	Grade 2	Grade 3
Lesion type
Mass	46 (67.65)1	12 (92.31)	53 (77.94)	2 (100.0)	50 (78.12)	3 (75.00)	34 (77.27)	21 (80.77)	11 (73.33)	25 (78.12)	30 (69.77)
Non-mass	22 (32.35)	1 (7.69)	15 (22.06)	0 (0.00)	14 (21.88)	1 (25.00)	10 (22.73)	5 (19.23)	4 (26.67)	7 (21.88)	13 (30.23)
p-value	0.141		1.000		1.000		0.966		0.721
Mass shape
Oval	15 (32.61)	9 (75.00)	22 (41.51)	1 (50.00)	22 (44.00)	0 (0.00)	17 (50.00)	6 (28.57)	2 (18.18)	9 (36.00)	17 (56.67)
Round	3 (6.52)	0 (0.00)	3 (5.66)	0 (0.00)	3 (6.00)	0 (0.00)	2 (5.88)	1 (4.76)	1 (9.09)	0 (0.00)	2 (6.67)
Irregular	28 (60.87)	3 (25.00)	28 (52.83)	1 (50.00)	25 (50.00)	3 (100.0)	15 (44.12)	14 (66.67)	8 (72.73)	16 (64.00)	11 (36.67)
p-value	0.027		0.928		0.242		0.258		0.091
Mass margin
Circumscribed	10 (21.74)	8 (66.67)	16 (30.19)	1 (50.00)	16 (32.00)	0 (0.00)	11 (32.35)	6 (28.57)	1 (9.09)	6 (24.00)	15 (50.00)
Irregular	30 (65.22)	3 (25.00)	30 (56.60)	1 (50.00)	27 (54.00)	3 (100.0)	19 (55.88)	12 (57.14)	7 (63.64)	16 (64.00)	12 (40.00)
Spiculated	6 (13.04)	1 (8.33)	7 (13.21)	0 (0.00)	7 (14.00)	0 (0.00)	4 (11.76)	3 (14.29)	3 (27.27)	3 (12.00)	3 (10.00)
p-value	0.011		0.770		0.296		0.938		0.069
Internal enhancement of mass
Homogeneous	1 (2.17)	1 (8.33)	1 (1.89)	0 (0.00)	1 (2.00)	0 (0.00)	0 (0.00)	1 (4.76)	1 (9.09)	2 (8.00)	0 (0.00)
Heterogeneous	24 (52.17)	5 (41.67)	27 (50.94)	1 (50.00)	25 (50.00)	2 (66.67)	18 (52.94)	10 (47.62)	9 (81.82)	17 (68.00)	9 (30.00)
Rim	21 (45.65)	6 (50.00)	25 (47.17)	1 (50.00)	24 (48.00)	1 (33.33)	16 (47.06)	10 (47.62)	1 (9.09)	6 (24.00)	21 (70.00)
p-value	0.523		0.980		0.842		0.429		0.001
Non-mass distribution
Focal	4 (18.18)	0 (0.00)	3 (20.00)	0 (0.00)	3 (21.43)	0 (0.00)	3 (30.00)	0 (0.00)	0 (0.00)	1 (14.29)	3 (23.08)
Segmental	17 (77.27)	0 (0.00)	10 (66.67)	0 (0.00)	10 (71.43)	0 (0.00)	7 (70.00)	3 (60.00)	4 (100.0)	5 (71.43)	9 (69.23)
Regional	1 (4.55)	0 (0.00)	1 (6.67)	0 (0.00)	1 (7.14)	0 (0.00)	0 (0.00)	1 (20.00)	0 (0.00)	1 (14.29)	0 (0.00)
Diffuse	0 (0.00)	1 (100.00)	1 (6.67)	0 (0.00)	0 (0.00)	1 (100.0)	0 (0.00)	1 (20.00)	0 (0.00)	0 (0.00)	1 (7.69)
p-value	< 0.001				0.002		0.136		0.584
Non-mass enhancement
Homogeneous	1 (4.55)	0 (0.00)	1 (6.67)	0 (0.00)	1 (7.14)	0 (0.00)	0 (0.00)	1 (20.00)	0 (0.00)	1 (14.29)	0 (0.00)
Heterogeneous	12 (54.55)	1 (100.00)	9 (60.00)	0 (0.00)	8 (57.14)	1 (100.0)	6 (60.00)	3 (60.00)	0 (0.00)	4 (57.14)	9 (69.23)
Clumped	6 (27.27)	0 (0.00)	4 (26.67)	0 (0.00)	4 (28.57)	0 (0.00)	3 (30.00)	1 (20.00)	2 (50.00)	2 (28.57)	2 (15.38)
Clustered ring	3 (13.64)	0 (0.00)	1 (6.67)	0 (0.00)	1 (7.14)	0 (0.00)	1 (10.00)	0 (0.00)	2 (50.00)	0 (0.00)	2 (15.38)
p-value	0.848				0.870		0.453		0.105
Kinetic curve type
Type 1	13 (19.12)	0 (0.00)	10 (14.71)	0 (0.00)	10 (15.62)	0 (0.00)	8 (18.18)	2 (7.69)	2 (13.33)	5 (15.62)	7 (16.28)
Type 2	17 (25.00)	5 (38.46)	17 (25.00)	0 (0.00)	16 (25.00)	1 (25.00)	12 (27.27)	5 (19.23)	5 (33.33)	7 (21.88)	12 (27.91)
Type 3	38 (55.88)	8 (61.54)	41 (60.29)	2 (100.00)	38 (59.38)	3 (75.00)	24 (54.55)	19 (73.08)	8 (53.33)	20 (62.50)	24 (55.81)
p-value	0.194		0.524		0.678		0.271		0.936

Table 4.

Results of Logistic Regression Analysis

Include Variables	B	SE	Odds Ratio (95% CI)	p-Value
For ER
Enhancement (for mass)
Rim	-3.223	0.910	0.04 (0.00–0.20)	< 0.001
For PR
Enhancement (for mass)
Rim	-2.363	0.695	0.09 (0.02–0.34)	< 0.001
For histologic grade
Enhancement (for mass)
Rim	2.012	0.620	7.48 (2.31–26.95)	0.001
For LN metastasis
Mass shape
Irregular	-2.054	0.847	0.13 (0.02–0.61)	0.015
Kinetic curve (for mass)
Type 3	-2.7218	0.8680	0.07 (0.01–0.31)	0.002

CI = confidence interval, ER = estrogen receptor, LN = lymph node, PR = progesterone receptor, SE = standard error

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