Imaging findings with clinicopathological correlation in breast carcinoma in young women

Objectives To evaluate the imaging features of malignant breast masses in young females on imaging modalities. To correlate the morphological features of these masses with histopathology and clinical features. Materials and Methods A retrospective study was conducted including 369 patients in whom image-guided core needle biopsy was performed between March 2023 and August 2023, out of which 71 patients under 40 years of age had breast carcinoma. The imaging features across mammography, ultrasonography, and magnetic resonance imaging were independently studied according to American College of Radiology Breast Imaging Reporting and Data System Lexicon criteria. The imaging findings were then correlated with clinical parameters and histopathology, immunohistochemistry, and the Ki67 index. Statistical analysis was performed using GraphPad prism software version 9. The chi-square test was used for all lists of proportions, and significance was assumed for p-values < 0.05. Results USG was performed in all 71 patients as the first imaging modality. The commonest finding detected on USG was a mass with an irregular shape and non-circumscribed margins, the most common being spiculated margins. Mammography was performed after clinical or ultrasound suspicion of malignancy. The commonest presentation was a mass with high density, irregular shape, and non-circumscribed margins. Microcalcifications were seen in association with other findings in 32% of the cases. However, isolated microcalcification was not seen in any of the cases in our study. Triple negative breast cancer was found to be the most common molecular subtype in our study. Conclusion Breast cancer in young women presents unique challenges due to its aggressive biological behavior, lack of screening, and advanced stage at diagnosis. The cancer usually presents as irregular masses with non-circumscribed margins on imaging. Radiologists and breast clinicians should be aware of the suspicious imaging findings of breast cancer in these young women across various modalities, and a high index of suspicion should be present for timely diagnosis and management, especially in those presenting with palpable lumps.