Bookmarks
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
- Triple-negative breast cancer (TNBC)
- Basal-like breast cancer (BLBC)
Definitions
- TNBC: Invasive carcinoma lacking expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)
- Cytokeratin and EGFR(+) in 70-80% (those that are BLBC); (-) in 20-30% of TNBC
- Worse prognosis if CK and EGFR(+)
- HER2 1+ on immunohistochemistry (IHC) is negative
- HER2 2+ on IHC prompts FISH, copy number ≥ 4.0 and ratio of ≥ 2.0 copies relative to chromosome 17 centromere is positive for gene amplification as is copy number ≥ 6.0 even if ratio is < 2.0
- HER2 3+ on IHC is positive
- Cytokeratin and EGFR(+) in 70-80% (those that are BLBC); (-) in 20-30% of TNBC
- PAM50 = 50-gene assay of RNA using formalin-fixed tissue to determine intrinsic molecular tumor subtype
- TNBC defined based on receptor expression and BLBC intrinsic subtype defined by genetic profiling
- ~ 10-12% of TNBC are HER2(+) intrinsic subtype; 3% luminal A; and 4% luminal B by PAM50 analysis
- ~ 70-77% of TNBC are BLBC
- Generally lack expression of ER, PR, and HER2
- ~ 6% of ER(+) disease basal-like by PAM50 analysis
- Strong expression of high-molecular-weight basal cytokeratins (e.g., CK5/6, CK14, and CK17) &/or EGFR
- Medullary, metaplastic, secretory, adenoid cystic carcinoma are subtypes of BLBC, latter 2 with good prognosis
- Generally lack expression of ER, PR, and HER2
- Claudin-low tumors: Poor prognosis ER/PR/HER2(-) IDC with high frequency of metaplastic and medullary differentiation
- TNBC: Invasive carcinoma lacking expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Imaging Recommendations
MR Findings
Nuclear Medicine Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Curigliano G: Addition of platinum salts to neoadjuvant chemotherapy in triple-negative breast cancer: a new standard of care? Lancet Oncol. 19(4):434-436, 2018
- Engel C et al: Prevalence of pathogenic BRCA1/2 germline mutations among 802 women with unilateral triple-negative breast cancer without family cancer history. BMC Cancer. 18(1):265, 2018
- McAndrew N et al: Neoadjuvant chemotherapy considerations in triple-negative breast cancer. J Target Ther Cancer. 7(1):52-69, 2018
- Schmid P et al: Atezolizumab and Nab-Paclitaxel in advanced triple-negative breast cancer. N Engl J Med. 379(22):2108-2121, 2018
- Tolba MF et al: Immunotherapy, an evolving approach for the management of triple negative breast cancer: Converting non-responders to responders. Crit Rev Oncol Hematol. 122:202-207, 2018
- Yoon GY et al: Sonographic features that can be used to differentiate between small triple-negative breast cancer and fibroadenoma. Ultrasonography. 37(2):149-156, 2018
- Yadav S et al: Impact of BRCA Mutation Status on Survival of Women With Triple-negative Breast Cancer. Clin Breast Cancer. ePub, 2017
- Zeng Z et al: Mammography and ultrasound effective features in differentiating basal-like and normal-like subtypes of triple negative breast cancer. Oncotarget. 8(45):79670-79679, 2017
- Doebar SC et al: Extent of ductal carcinoma in situ according to breast cancer subtypes: a population-based cohort study. Breast Cancer Res Treat. 158(1):179-87, 2016
- Plasilova ML et al: Features of triple-negative breast cancer: Analysis of 38,813 cases from the national cancer database. Medicine (Baltimore). 95(35):e4614, 2016
- Schmadeka R et al: Triple-negative breast carcinoma: current and emerging concepts. Am J Clin Pathol. 141(4):462-77, 2014
- Groheux D et al: Triple-negative breast cancer: early assessment with 18F-FDG PET/CT during neoadjuvant chemotherapy identifies patients who are unlikely to achieve a pathologic complete response and are at a high risk of early relapse. J Nucl Med. 53(2):249-54, 2012
- Iorfida M et al: Invasive lobular breast cancer: subtypes and outcome. Breast Cancer Res Treat. 133(2):713-23, 2012
- Groheux D et al: Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer. Eur J Nucl Med Mol Imaging. 38(3):426-35, 2011
- Koo JS et al: Clinicopathlogic and immunohistochemical characteristics of triple negative invasive lobular carcinoma. Yonsei Med J. 52(1):89-97, 2011
- Reis-Filho JS et al: Gene expression profiling in breast cancer: classification, prognostication, and prediction. Lancet. 378(9805):1812-23, 2011
- Whitman GJ et al: Triple-negative breast cancer: what the radiologist needs to know. Semin Roentgenol. 46(1):26-39, 2011
- Dogan BE et al: Multimodality imaging of triple receptor-negative tumors with mammography, ultrasound, and MRI. AJR Am J Roentgenol. 194(4):1160-6, 2010
- Hama Y et al: Early distant relapse in early stage triple-negative breast cancer: usefulness of FDG-PET for diagnosis of distant metastases. Breast Cancer. Epub ahead of print, 2010
- Ko ES et al: Triple-negative breast cancer: correlation between imaging and pathological findings. Eur Radiol. 20(5):1111-7, 2010
- Tchou J et al: Degree of tumor FDG uptake correlates with proliferation index in triple negative breast cancer. Mol Imaging Biol. 12(6):657-62, 2010
- Voduc KD et al: Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 28(10):1684-91, 2010
- Dent R et al: Pattern of metastatic spread in triple-negative breast cancer. Breast Cancer Res Treat. 115(2):423-8, 2009
- Foulkes WD et al: Tumor size is an unreliable predictor of prognosis in basal-like breast cancers and does not correlate closely with lymph node status. Breast Cancer Res Treat. 117(1):199-204, 2009
- Ma H et al: Is there a difference in the association between percent mammographic density and subtypes of breast cancer? Luminal A and triple-negative breast cancer. Cancer Epidemiol Biomarkers Prev. 18(2):479-85, 2009
- Moran MS et al: The Yale University experience of early-stage invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) treated with breast conservation treatment (BCT): analysis of clinical-pathologic features, long-term outcomes, and molecular expression of COX-2, Bcl-2, and p53 as a function of histology. Breast J. 15(6):571-8, 2009
- Uematsu T et al: Triple-negative breast cancer: correlation between MR imaging and pathologic findings. Radiology. 250(3):638-47, 2009
- Basu S et al: Comparison of triple-negative and estrogen receptor-positive/progesterone receptor-positive/HER2-negative breast carcinoma using quantitative fluorine-18 fluorodeoxyglucose/positron emission tomography imaging parameters: a potentially useful method for disease characterization. Cancer. 112(5):995-1000, 2008
- Liedtke C et al: Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 26(8):1275-81, 2008
- Smid M et al: Subtypes of breast cancer show preferential site of relapse. Cancer Res. 68(9):3108-14, 2008
- Yang WT et al: Mammographic features of triple receptor-negative primary breast cancers in young premenopausal women. Breast Cancer Res Treat. 111(3):405-10, 2008
- Chen JH et al: Magnetic resonance imaging in predicting pathological response of triple negative breast cancer following neoadjuvant chemotherapy. J Clin Oncol. 25(35):5667-9, 2007
- Chen JH et al: Triple-negative breast cancer: MRI features in 29 patients. Ann Oncol. 18(12):2042-3, 2007
- Dent R et al: Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 13(15 Pt 1):4429-34, 2007
- Carey LA et al: Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 295(21):2492-502, 2006
- Livasy CA et al: Phenotypic evaluation of the basal-like subtype of invasive breast carcinoma. Mod Pathol. 19(2):264-71, 2006
- Brenton JD et al: Molecular classification and molecular forecasting of breast cancer: ready for clinical application? J Clin Oncol. 23(29):7350-60, 2005
- Collett K et al: A basal epithelial phenotype is more frequent in interval breast cancers compared with screen detected tumors. Cancer Epidemiol Biomarkers Prev. 14(5):1108-12, 2005
- Rouzier R et al: Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 11(16):5678-85, 2005
- Sørlie T: Molecular portraits of breast cancer: tumour subtypes as distinct disease entities. Eur J Cancer. 40(18):2667-75, 2004
- Perou CM et al: Molecular portraits of human breast tumours. Nature. 406(6797):747-52, 2000
- Sørlie T et al: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 98(19):10869-74, 2001
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
- Triple-negative breast cancer (TNBC)
- Basal-like breast cancer (BLBC)
Definitions
- TNBC: Invasive carcinoma lacking expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)
- Cytokeratin and EGFR(+) in 70-80% (those that are BLBC); (-) in 20-30% of TNBC
- Worse prognosis if CK and EGFR(+)
- HER2 1+ on immunohistochemistry (IHC) is negative
- HER2 2+ on IHC prompts FISH, copy number ≥ 4.0 and ratio of ≥ 2.0 copies relative to chromosome 17 centromere is positive for gene amplification as is copy number ≥ 6.0 even if ratio is < 2.0
- HER2 3+ on IHC is positive
- Cytokeratin and EGFR(+) in 70-80% (those that are BLBC); (-) in 20-30% of TNBC
- PAM50 = 50-gene assay of RNA using formalin-fixed tissue to determine intrinsic molecular tumor subtype
- TNBC defined based on receptor expression and BLBC intrinsic subtype defined by genetic profiling
- ~ 10-12% of TNBC are HER2(+) intrinsic subtype; 3% luminal A; and 4% luminal B by PAM50 analysis
- ~ 70-77% of TNBC are BLBC
- Generally lack expression of ER, PR, and HER2
- ~ 6% of ER(+) disease basal-like by PAM50 analysis
- Strong expression of high-molecular-weight basal cytokeratins (e.g., CK5/6, CK14, and CK17) &/or EGFR
- Medullary, metaplastic, secretory, adenoid cystic carcinoma are subtypes of BLBC, latter 2 with good prognosis
- Generally lack expression of ER, PR, and HER2
- Claudin-low tumors: Poor prognosis ER/PR/HER2(-) IDC with high frequency of metaplastic and medullary differentiation
- TNBC: Invasive carcinoma lacking expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Imaging Recommendations
MR Findings
Nuclear Medicine Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Curigliano G: Addition of platinum salts to neoadjuvant chemotherapy in triple-negative breast cancer: a new standard of care? Lancet Oncol. 19(4):434-436, 2018
- Engel C et al: Prevalence of pathogenic BRCA1/2 germline mutations among 802 women with unilateral triple-negative breast cancer without family cancer history. BMC Cancer. 18(1):265, 2018
- McAndrew N et al: Neoadjuvant chemotherapy considerations in triple-negative breast cancer. J Target Ther Cancer. 7(1):52-69, 2018
- Schmid P et al: Atezolizumab and Nab-Paclitaxel in advanced triple-negative breast cancer. N Engl J Med. 379(22):2108-2121, 2018
- Tolba MF et al: Immunotherapy, an evolving approach for the management of triple negative breast cancer: Converting non-responders to responders. Crit Rev Oncol Hematol. 122:202-207, 2018
- Yoon GY et al: Sonographic features that can be used to differentiate between small triple-negative breast cancer and fibroadenoma. Ultrasonography. 37(2):149-156, 2018
- Yadav S et al: Impact of BRCA Mutation Status on Survival of Women With Triple-negative Breast Cancer. Clin Breast Cancer. ePub, 2017
- Zeng Z et al: Mammography and ultrasound effective features in differentiating basal-like and normal-like subtypes of triple negative breast cancer. Oncotarget. 8(45):79670-79679, 2017
- Doebar SC et al: Extent of ductal carcinoma in situ according to breast cancer subtypes: a population-based cohort study. Breast Cancer Res Treat. 158(1):179-87, 2016
- Plasilova ML et al: Features of triple-negative breast cancer: Analysis of 38,813 cases from the national cancer database. Medicine (Baltimore). 95(35):e4614, 2016
- Schmadeka R et al: Triple-negative breast carcinoma: current and emerging concepts. Am J Clin Pathol. 141(4):462-77, 2014
- Groheux D et al: Triple-negative breast cancer: early assessment with 18F-FDG PET/CT during neoadjuvant chemotherapy identifies patients who are unlikely to achieve a pathologic complete response and are at a high risk of early relapse. J Nucl Med. 53(2):249-54, 2012
- Iorfida M et al: Invasive lobular breast cancer: subtypes and outcome. Breast Cancer Res Treat. 133(2):713-23, 2012
- Groheux D et al: Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer. Eur J Nucl Med Mol Imaging. 38(3):426-35, 2011
- Koo JS et al: Clinicopathlogic and immunohistochemical characteristics of triple negative invasive lobular carcinoma. Yonsei Med J. 52(1):89-97, 2011
- Reis-Filho JS et al: Gene expression profiling in breast cancer: classification, prognostication, and prediction. Lancet. 378(9805):1812-23, 2011
- Whitman GJ et al: Triple-negative breast cancer: what the radiologist needs to know. Semin Roentgenol. 46(1):26-39, 2011
- Dogan BE et al: Multimodality imaging of triple receptor-negative tumors with mammography, ultrasound, and MRI. AJR Am J Roentgenol. 194(4):1160-6, 2010
- Hama Y et al: Early distant relapse in early stage triple-negative breast cancer: usefulness of FDG-PET for diagnosis of distant metastases. Breast Cancer. Epub ahead of print, 2010
- Ko ES et al: Triple-negative breast cancer: correlation between imaging and pathological findings. Eur Radiol. 20(5):1111-7, 2010
- Tchou J et al: Degree of tumor FDG uptake correlates with proliferation index in triple negative breast cancer. Mol Imaging Biol. 12(6):657-62, 2010
- Voduc KD et al: Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 28(10):1684-91, 2010
- Dent R et al: Pattern of metastatic spread in triple-negative breast cancer. Breast Cancer Res Treat. 115(2):423-8, 2009
- Foulkes WD et al: Tumor size is an unreliable predictor of prognosis in basal-like breast cancers and does not correlate closely with lymph node status. Breast Cancer Res Treat. 117(1):199-204, 2009
- Ma H et al: Is there a difference in the association between percent mammographic density and subtypes of breast cancer? Luminal A and triple-negative breast cancer. Cancer Epidemiol Biomarkers Prev. 18(2):479-85, 2009
- Moran MS et al: The Yale University experience of early-stage invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) treated with breast conservation treatment (BCT): analysis of clinical-pathologic features, long-term outcomes, and molecular expression of COX-2, Bcl-2, and p53 as a function of histology. Breast J. 15(6):571-8, 2009
- Uematsu T et al: Triple-negative breast cancer: correlation between MR imaging and pathologic findings. Radiology. 250(3):638-47, 2009
- Basu S et al: Comparison of triple-negative and estrogen receptor-positive/progesterone receptor-positive/HER2-negative breast carcinoma using quantitative fluorine-18 fluorodeoxyglucose/positron emission tomography imaging parameters: a potentially useful method for disease characterization. Cancer. 112(5):995-1000, 2008
- Liedtke C et al: Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 26(8):1275-81, 2008
- Smid M et al: Subtypes of breast cancer show preferential site of relapse. Cancer Res. 68(9):3108-14, 2008
- Yang WT et al: Mammographic features of triple receptor-negative primary breast cancers in young premenopausal women. Breast Cancer Res Treat. 111(3):405-10, 2008
- Chen JH et al: Magnetic resonance imaging in predicting pathological response of triple negative breast cancer following neoadjuvant chemotherapy. J Clin Oncol. 25(35):5667-9, 2007
- Chen JH et al: Triple-negative breast cancer: MRI features in 29 patients. Ann Oncol. 18(12):2042-3, 2007
- Dent R et al: Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 13(15 Pt 1):4429-34, 2007
- Carey LA et al: Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 295(21):2492-502, 2006
- Livasy CA et al: Phenotypic evaluation of the basal-like subtype of invasive breast carcinoma. Mod Pathol. 19(2):264-71, 2006
- Brenton JD et al: Molecular classification and molecular forecasting of breast cancer: ready for clinical application? J Clin Oncol. 23(29):7350-60, 2005
- Collett K et al: A basal epithelial phenotype is more frequent in interval breast cancers compared with screen detected tumors. Cancer Epidemiol Biomarkers Prev. 14(5):1108-12, 2005
- Rouzier R et al: Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 11(16):5678-85, 2005
- Sørlie T: Molecular portraits of breast cancer: tumour subtypes as distinct disease entities. Eur J Cancer. 40(18):2667-75, 2004
- Perou CM et al: Molecular portraits of human breast tumours. Nature. 406(6797):747-52, 2000
- Sørlie T et al: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci U S A. 98(19):10869-74, 2001
