Imaging of triple-negative breast cancer

Although triple-negative breast cancer (TNBC) has been studied extensively in the oncology and pathology literature, there are few reports on imaging features. Emerging data suggest that imaging features of TNBC are substantially different from other primary breast cancer immunotypes. In this work, we reviewed multi-modality imaging features of primary TNBC with emphasis on the appropriate niche for each technology in diagnosis, staging and management. TNBC lacks the typical suspicious mammographic features of breast cancer; namely irregular mass shape, spiculated margins and associated suspicious calcifications. Therefore, mammography alone is usually a sub-optimal tool for its initial diagnostic evaluation. Ultrasound has a much higher sensitivity, although its diagnostic capability may be impaired by associated benign features encountered in 21%-41% of TNBC lesions. Magnetic resonance imaging (MRI) consistently demonstrates the presence of all TNBC with a higher level of accuracy compared with other tumour sub-types, and provides a reliable baseline for neoadjuvant chemotherapy (NAC) follow-up. Preliminary studies also suggest that MRI may predict complete NAC response in TNBC more sensitively than other methods. [F-18]2-fluoro-2-deoxy-D-glucose positron emission tomography (F-18-FDG-PET) has a higher sensitivity for TNBC than estrogen-positive and human epidermal growth factor receptor 2-positive tumours, and axillary lymph node metastases are detected with more accuracy compared with other tumour molecular sub-types, although low FDG uptake of breast cancers in general may limit the routine clinical use of F-18-FDG-PET in the initial diagnosis of TNBC patients and NAC follow-up.