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Estrogen Receptor–Negative Invasive Breast Cancer: Imaging Features of Tumors with and without Human Epidermal Growth Factor Receptor Type 2 Overexpression¹

¹ From the Departments of Surgery (Y.W., S.S.J.), Radiology (D.M.I., S.P., R.J.J.), Health Research and Policy (B.N.), and Pathology (T.A.L.), Stanford University School of Medicine, Medical School Lab Surge Bldg Room P214, 1201 Welch Rd, Stanford, CA 94305-5494; and Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pa (R.J.B.). Received January 25, 2007; revision requested March 16; revision received May 11; accepted June 11; final version accepted July 23. S.S.J. supported in part by the California Breast Cancer Research Program of the University of California (grant 11IB-0175). Address correspondence to S.S.J. (e-mail: ssj{at}stanford.edu).

Purpose: To prospectively determine if estrogen receptor (ER)-negative human epidermal growth factor receptor type 2 (HER2)-positive and ER-negative HER2-negative breast cancers have distinguishing clinical and imaging features with use of retrospectively identified patients and tissue samples.

Materials and Methods: This HIPAA-compliant study was institutional review board approved. Informed consent was obtained from living patients and waived for deceased patients. Mean patient age at diagnosis was 53 years (range, 31–84 years). Clinical history; histopathologic, mammographic, and breast sonographic findings; and HER2 status as determined with immunohistochemistry or fluorescent in situ hybridization were evaluated in 56 women with ER-negative breast cancer. Imaging appearances and clinicopathologic characteristics were correlated with tumor HER2 status. P < .05 indicated a significant difference.

Results: Lesion margins on mammograms (P = .028) and sonograms (P = .023), calcifications on mammograms (P = .003), and clinical cancer stage at diagnosis (P = .029) were significantly associated with HER2 status. In contrast to ER-negative HER2-negative tumors, ER-negative HER2-positive tumors were more likely to have spiculated margins (56% vs 15%), be associated with calcifications (65% vs 21%), and be detected at a higher cancer stage (74% vs 57%).

Conclusion: Biologic diversity of cancers may manifest in imaging characteristics, and, conversely, studying the range of imaging features of cancers may help refine current molecular phenotypes.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2462070169/DC1

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