Imaging Study Of The Metastasis Difference Between Triple Negative Breast Cancer And Non-Triple Negative Breast Cancer

Objective:To investigate the imaging features of triple negative breast cancer(TNBC)metastasis and compare with non-triple negative breast cancer(NTNBC).Methods:The clinical and imaging follow-up data of 75 patients with breast cancer metastasis from July 2011 to March 2016 were retrospectively analyzed.According to immunohistochemistry,the patients were divided into TNBC metastasis group and NTNBC metastasis group.To analyze the differences between TNBC metastasis and NTNBC metastasis in age of onset,size of primary tumors,operation mode,pathological type,period of first finding metastasis in imaging follow-up,location of metastasis,characteristics of metastasis(location,size,shape,margin,enhance)in imaging examination.Results:Among 75 cases of breast cancer metastasis,20 cases were TNBC metastasis and 55 cases were NTNBC metastasis.(1)Age of onset:In TNBC metastasis group,7cases(35.0%)were?40 years old,10 cases(50.0%)were>40 years old and?60 years old,3 cases(15.0%)were>60 years old.In NTNBC metastasis group,4 cases(7.3%)were?40 years old,31 cases(56.4%)were>40 years old and?60 years old,20 cases(36.4%)were>60 years old.The difference in age of onset between TNBC metastatic group and NTNBC metastatic group was statistically significant(?~2=9.979,P=0.007).Compared between groups,the difference between?40 years old and>60 years old was statistically significant(?~2=8.904,P=0.003).(2)The largest diameter of primary tumors:In TNBC metastasis group,7 cases(35.0%)were?2 cm,3 cases(15.0%)were>2 cm and?5 cm,10 cases(50.0%)were>5 cm.In NTNBC metastasis group,19 cases(34.5%)were?2 cm,23 cases(41.8%)were>2 cm and?5 cm,13 cases(23.6%)were>5 cm.The difference in the maximum diameter of primary tumor between TNBC metastatic group and NTNBC metastatic group was statistically significant(?~2=6.368,P=0.041).Compared between groups,the difference between>2cm and?5 cm and>5 cm was statistically significant(?~2=6.257,P=0.012).(3)Surgical methods:In TNBC metastasis group,14 cases(70.0%)underwent modified radical resection,6 cases(30.0%)underwent non-modified radical resection.In NTNBC metastasis group,34 cases(61.8%)underwent modified radical resection,21 cases(38.2%)underwent non-modified radical resection.There was no significant difference in surgical methods between TNBC metastatic group and NTNBC metastatic group(?~2=0.426,P=0.514).(4)Pathological types of primary tumors:16 cases(80.0%)of invasive ductal carcinoma and 4 cases(20.0%)of other pathological types in TNBC metastasis group.50 cases(90.9%)of invasive ductal carcinoma and 5 cases(9.1%)of other pathological types in NTNBC metastasis group.There was no significant difference in pathological types between TNBC metastatic group and NTNBC metastatic group(?~2=1.653,P=0.199).(5)Metastasis sites:In TNBC metastasis group,12 cases(40.0%)of lung metastasis,5 cases(16.7%)of liver metastasis,5 cases(16.7%)of brain metastasis,8 cases(26.7%)of bone metastasis.In NTNBC metastasis group,28cases(35.4%)of lung metastasis,12 cases(15.2%)of liver metastasis,3 cases(3.8%)of brain metastasis,36 cases(45.6%)of bone metastasis.There was no significant difference in metastasis sites between TNBC metastatic group and NTNBC metastatic group(?~2=6.984,P=0.072).(6)The first period of metastasis was found in imaging follow-up:(1)?1 year:In TNBC metastasis group,6 cases(20.0%)of lung metastasis,3 cases(10.0%)of liver metastasis,2 cases(6.7%)of brain metastasis,3 cases(10.0%)of bone metastasis.In NTNBC metastasis group,15 cases(19.0%)of lung metastasis,5cases(6.3%)of liver metastasis,2 cases(2.5%)of brain metastasis,21 cases(26.6%)of bone metastasis.(2)>1 year and?3 years:In TNBC metastasis group,5 cases(16.7%)of lung metastasis,2 cases of liver metastasis(6.7%),3 cases of brain metastasis(10.0%),5 cases of bone metastasis(16.7%).In NTNBC metastasis group,11 cases(13.9%)of lung metastasis,7 cases(8.9%)of liver metastasis,no brain metastasis and10 cases(12.7%)of bone metastasis.(3)>3 years:In TNBC metastasis group,1 case(3.3%)of lung metastasis,none of liver metastasis,brain metastasis and bone metastasis.In NTNBC metastasis group,2 cases(2.5%)of lung metastasis,no liver metastases,1case(1.3%)of brain metastases,5 cases(6.3%)of bone metastases.(7)The characteristics of metastases in imaging examination were as follows:(1)In TNBC metastasis group,12 cases of lung metastasis,which the maximum diameter was 0.6-2.5cm,including 3 cases(25.0%)in right lung and 9 cases(75.0%)in multiple lung,11cases(91.7%)were round and 1 case(8.3%)was irregular in shape,9 cases(75.0%)had clear margins and 3 cases(25.0%)had blurred margins,non-enhanced CT value(28.00±5.57)HU,arterial phase CT value(66.00±11.14)HU.In NTNBC metastasis group,28 cases of lung metastasis,which the maximum diameter was 0.3-3.7 cm,including 3 cases(10.7%)in left lung,4 cases(14.3%)in right lung and 21 cases(75.0%)in multiple lung,24 cases(85.7%)were round and 4 cases(14.3%)were irregular in shape,20 cases(71.4%)had clear margins and 8 cases(28.6%)had blurred margins,non-enhanced CT value(25.67±9.02)HU,arterial phase CT value(62.67±5.69)HU.The difference between the two groups in lung metastasis site,morphology,margin andCTvaluewerenosignificant(?~2=1.837,P=0.503;?~2=0.272,P=0.602;?~2=0.054,P=0.817;t=0.381,P=0.726;t=0.462,P=0.676).(2)In TNBC metastasis group,5 cases of liver metastasis,which the maximum diameter was 1.3-3.0 cm,all of which were multiple,4 cases(80.0%)were round and 1 case(20.0%)was irregular in shape.4cases(80.0%)had clear margins and 1 cases(20.0%)had blurred margins,35 lesions(81.4%)were annular enhancement,8 lesions(18.6%)were non-annular enhancement.In NTNBC metastasis group,12 cases of liver metastasis,which the maximum diameter was 0.6-7.5 cm,including 2 cases(16.7%)in left liver,3 cases(25.0%)in right liver and 7 cases(58.3%)in multiple liver metastases,9 cases(75.0%)were round and 3cases(25.0%)were irregular in shape,2 cases(16.7%)had clear margins and 10 cases(83.3%)had blurred margins,58 lesions(68.2%)were annular enhancement,27 lesions(31.8%)were non-annular enhancement.The difference between the two groups in liver metastatic margins was significant(?~2=6.199,P=0.028),but no statistically significant differences in site,morphology,and enhancement mode(?~2=2.137,P=0.387;?~2=0.049,P=0.825;?~2=2.489,P=0.143).(3)In TNBC metastasis group,5 cases of brain metastasis,which the maximum diameter was 0.9-4.0 cm,including 1 case(20.0%)in left brain,1 case(20.0%)in right brain and 3 cases(60.0%)in multiple brain parenchyma,3 cases(60.0%)were round and 2 cases(40.0%)were irregular in shape,the margins were blurred.18 lesions(85.7%)were annular enhancement,3 lesions(14.3%)were non-annular enhancement.In NTNBC metastasis group,3 cases of brain metastasis,which the maximum diameter was 0.5-2.0 cm,all of which were multiple,2cases(66.7%)were round and 1 case(33.3%)was irregular in shape,the margins were blurred,23 lesions(79.3%)were annular enhancement,6 lesions(20.7%)were non-annular enhancement.The difference between the two groups in brain metastasis site,morphology,edge and enhancement mode were no significant(?~2=1.600,P=0.449;?~2=0.036,P=0.850;?~2=0.500,P=0.480;?~2=0.338,P=0.561).(4)In TNBC metastasis group,8 cases of bone metastasis,including 5 cases(62.5%)in spine bone,3 cases(37.5%)in non-spine bone,2 cases(25.0%)of osteogenic metastasis and 6 cases(75.0%)of osteoclastic metastasis.In NTNBC metastasis group,36 cases of bone metastasis,including 23 cases(63.9%)in spine bone,13 cases(36.1%)in non-spine bone,8 cases(22.2%)of osteogenic metastasis and 28 cases(77.8%)of osteoclastic metastasis.The difference between the two groups in bone metastasis site and morphology were no significant(?~2=0.005,P=0.941;?~2=0.029,P=0.865).Conclusion:(1)The metastasis of TNBC patients was more likely to occur at?40 years old,or the size of primary tumors were>5 cm;NTNBC patients was more likely to occur at>60 years old,or the primary tumors were>2 cm and?5 cm.Both of them were invasive ductal carcinoma commonly,the primary surgical approach had no effect on the incidence of metastasis.(2)TNBC was prone to lung and liver metastasis within1 year,chest CT and upper abdominal MRI should be focused on;Brain and bone metastases were likely to occur within 1-3 years,Craniocerebral MRI and bone ECT should be focused on.NTNBC was prone to lung and bone metastasis within 1 year,and should focused on chest CT and bone ECT;Liver metastasis was likely to occur within 1-3 years,and MRI of the upper abdomen should be focused on.(3)The edge of TNBC liver metastasis was clear,NTNBC liver metastasis was fuzzy,but both showed multiple,round-like and mainly annular enhancement.The lung and brain metastases of TNBC and NTNBC were multiple and round-like.The margins of lung metastases were clear,and there was no difference in CT values between plain scan and arterial phase.The margins of brain metastases were blurred and ring enhancement was dominant.In addition,osteoclastic spinal bone metastases were common in both groups.