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Less common presentations of TNBC include a focal asymmetry, seen in 10-20% of cases, or a mass with associated calcifications, seen in approximately 15% of cases. Circumscribed margins are described in approximately one-fourth of cases, and there are typically no associated calcifications. The most common presentation of TNBC on mammography is a mass (Figure 1). As such, TNBC can be mammographically occult (in up to 18% of cases), despite often being larger than other breast cancers at the time of diagnosis. TNBC usually lacks the spiculated margins, irregular shape, and suspicious calcifications associated with other forms of breast cancer.

This review will provide an overview of this topic with a focus on the imaging features, treatment implications, and prognostic factors relevant to TNBC. Because of its aggressive behavior, unique imaging features, and treatment limitations, it is important that all clinicians caring for breast cancer patients have a broad understanding of TNBC. Since TNBC lacks a molecular target, options for systemic therapy are limited as compared to tumors which express ER, PR, and HER2. It also has distinctive imaging features, often lacking the suspicious mammographic findings associated with other forms of breast cancer. TNBC comprises 11-20% of all breast cancers but is responsible for 23-28% of locally advanced disease. TNBC is defined as a breast cancer that does not express receptors for estrogen (ER), progesterone (PR), or human epidermal growth factor 2 (HER2). Triple negative breast cancer (TNBC) is one subtype that is of particular interest due to its poor prognosis, aggressive biology, and associations with TP53 gene mutations and suppressed BRCA1 function. It is a heterogeneous disease, with many biologically distinct subtypes having widely different clinical presentations, biological aggressiveness, and responses to therapy. As this subtype accounts for up to one-fifth of all breast cancer cases, a thorough understanding of the unique imaging features of triple-negative breast cancer, as well as the role of imaging in predicting response to therapy and long term patient prognosis, will allow all involved clinicians to more effectively care for these patients.īreast cancer, Triple negative, Mammography, Neoadjuvant chemotherapy, Pathologic complete remissionīreast cancer is the most common malignancy among women in developed countries and is a leading cause of cancer death. Despite this, patients with triple-negative breast cancer have an overall poorer prognosis compared to other subtypes, especially in the first few years after diagnosis.

Patients with triple-negative breast cancer are more likely to achieve pathologic complete remission, which is associated with improved survival. Fortunately, Triple-negative breast cancer is very responsive to neoadjuvant chemotherapy, which is the mainstay of treatment for these patients. Triple-negative breast cancer also has unique treatment limitations, with these cancers lacking molecular therapeutic targets expressed by other breast cancer subtypes. It has distinct imaging features, often presenting as a mass with typically benign features on mammography and ultrasound and more suspicious findings on magnetic resonance imaging. Triple-negative breast cancer is a subtype with significant clinical implications because of its poor prognosis and aggressive behavior.

Breast cancer is a heterogeneous disease, with many distinct subtypes having extremely different presentations, biological aggressiveness, and response to therapy.