Clinical Features and Presentation of Triple Negative Breast Cancers

• The majority of TNBCs are detected clinically as a:
  • Mass, either by the patient or examining clinician
• Other possible presenting symptoms include:
  • Breast pain
  • Bloody nipple discharge
• In the institutional review by Krizmanich-Conniff and colleagues, when compared with non-TNBCs:
  • TNBCs were more likely to present clinically:
    • 68% versus 48%
  • The remaining 32% of TNBCs were found on screening mammography:
    • Whereas 52% of non-TNBCs were found by screening
• More than one-third of patients whose TNBC was detected clinically had no prior mammography:
  • Of those detected by mammography:
    • One-third had developed within 12 months of the last mammography:
      • The high incidence of interval cancers is attributed to the aggressive growth rate of TNBC
• Imaging:
  • Mammographic characteristics of TNBC included:
    • A round mass (59.3%) or an oval or lobulated mass (65%), with circumscribed (15%), microlobulated (12.5%), or indistinct margins (55%)
    • Spiculated margins were much less common (15%)
• On mammography, TNBCs are most likely seen as:
  • A noncalcified mass:
    • 58%
• Dogan and Turnbull caution that TNBC may lack the typical mammographic features of breast cancer, and although ultrasonography adds to the sensitivity of diagnosis:
  • 21% to 41% of TNBCs can have benign characteristics on breast imaging
• On MRI, the most common enhancement pattern seen with TNBC is rim enhancement:
  • MRI findings following neoadjuvant chemotherapy (NAC):
    • Correlate well with the extent of residual tumor
  • MRI provides a reliable baseline prior to NAC and can predict response more sensitively than other imaging methods

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