Breast cancer diagnosed before the 40 years: imaging findings and correlation with histology and molecular subtype

Background: To evaluate the imaging findings in patients with breast cancer diagnosed before age 40 and their correlation with histological type and molecular subtype. Methods: A descriptive, retrospective, single-center study was conducted by reviewing imaging exams and medical records, after approval of the institution's Ethics Review Board. Among the 120 patients studied, 112 (93.3%) had mammography, 113 (94.2%) underwent ultrasonography and 105 (87.5%) underwent breast magnetic resonance imaging (MRI). Histopathology data was performed in most cases after surgical resection, which was available for 113 patients (94.2%). Results: The mean age at diagnosis of primary breast cancer was 34 years. Most patients had no family history of breast cancer or ovarian cancer (60.7%), and were symptomatic at diagnosis (75.6%). The most common histological type was no-special type (NST) invasive carcinoma (73.8%). Regarding the molecular subtype, luminal B was the most common (42.6%), followed by triple negative (20.2%). The malignant tumor was identified in 92.9% of patients who underwent mammography, 96.5% of patients submitted to ultrasound and 98% of those who performed MRI. MRI was superior to other methods in the evaluation of multifocal and multicentric lesions. There was no statistically significant association between imaging findings and molecular subtypes in the present study. Conclusions: This study demonstrated that imaging methods play a fundamental role in the characterization of cases of breast cancer diagnosed in patients younger than 40 years. Despite the ultrasound has been the most widely used method, we found improved characterization of breast lesions when also used mammography and MRI (AU)

Breast cancer features in women under the age of 40 years / Perfil do câncer de mama em mulheres com idade inferior a 40 anos

Summary Objective: To describe the clinical features, imaging findings and pathological aspects of breast cancer diagnosed in women under the age of 40 years. Method: A retrospective, descriptive study was performed through analysis of medical records between November 2008 and August 2012. One hundred and twenty (120) patients were included, of whom 112 underwent mammography, 113 underwent ultrasonography, and 105 underwent magnetic resonance imaging (MRI). The histopathological data was obtained in most cases from post-surgical analysis, which was available for 113 patients. Results: The mean age at diagnosis of primary breast cancer was 34 years. Only 11 patients (9.0%) had a family history of breast or ovarian cancer in first-degree relative. Ninety-two (92) patients sought medical attention after showing breast symptoms, and the presence of a palpable nodule was the main complaint. One hundred and twenty-two (122) primary tumors were diagnosed, of which 112 were invasive (95%). The most common histological type was invasive ductal carcinoma (73.8%). Luminal B was the predominant molecular subtype (42.6%). Ultrasonography was positive in 94.5% of the cases and the most common finding were nodules (94.8%). At mammography, the malignancy was observed in 92.8% and the presence of suggestive calcifications was the dominant feature. The MRI was positive in 98% of patients, and mass lesions were the most common. Conclusion: Most cases of breast cancer diagnosed in patients under the age of 40 years, in our population, had symptoms at diagnosis and tumor with more aggressive biological behavior. Despite the ultrasound has been the most widely used method, we found improved characterization of breast lesions when also used mammography and MRI.

Resumo Objetivo: descrever o perfil clínico, os achados de imagem e os aspectos anatomopatológicos do câncer de mama em mulheres com idade inferior a 40 anos. Método: estudo retrospectivo, descritivo, com análise de prontuários de novembro de 2008 a agosto de 2012. Foram estudadas 120 pacientes, das quais 112 realizaram mamografia, 113 ultrassonografia e 105 ressonância magnética (RM). A coleta dos dados histopatológicos foi realizada com informações pós-cirúrgicas, disponíveis para 113 pacientes. Resultados: a idade média ao diagnóstico da neoplasia da mama foi 34 anos. Apenas 11 pacientes (9,0%) apresentaram história familiar positiva para câncer de mama/ovário em parente de primeiro grau. Noventa e duas pacientes (92) procuraram atendimento médico após apresentarem sintomas mamários, sendo nódulo palpável a principal queixa referida. Foram diagnosticados 122 tumores primários, dos quais 112 eram invasivos (95%). O tipo histológico mais encontrado foi o carcinoma ductal invasivo (73,8%). Em relação ao subtipo molecular, o luminal B foi predominante (42,6%). A ultrassonografia foi positiva em 94,5% dos casos e o achado mais comum foi nódulo (94,8%). Na mamografia, a lesão maligna foi evidenciada em 92,8% e a presença de calcificações suspeitas foi o padrão dominante. O exame de RM foi positivo em 98% dos pacientes, sendo lesões tipo massa as mais comuns. Conclusão: a maioria dos casos de câncer de mama em pacientes com idade inferior a 40 anos apresentavam sintomas ao diagnóstico e tumores de comportamento biológico mais agressivo. Apesar de a ultrassonografia ter sido o método mais utilizado, observamos uma melhora da caracterização das lesões mamárias quando utilizadas também a mamografia e a RM.