Dynamic breast magnetic resonance imaging features and pathological correlation of patients diagnosed with breast cancer under the age of 40

Abstract

Background

Young-onset breast cancer (≤40 years) may demonstrate distinct magnetic resonance imaging (MRI) features compared with older patients, and recognition of age-related phenotypes may improve radiologic–pathologic correlation.

Purpose

To evaluate dynamic breast MRI features of young-onset breast cancer, assess their correlation with histopathological characteristics, and compare these findings with those observed in an older patient population.

Material and Methods

This retrospective study included 160 women with breast cancer (80 aged ≤40 years; 80 aged ≥50 years). Breast density, background parenchymal enhancement (BPE), edema, skin thickness, lesion margins, T2 signal intensity, rim enhancement, internal enhancement pattern, kinetic curve type, ADC values were assessed according to ACR BI-RADS MRI lexicon. Histopathological features were extracted from pathology reports. Statistical analyses were performed using SPSS.

Results

Younger women more frequently demonstrated dense fibroglandular tissue, higher BPE, rim enhancement, T2 iso- to hyperintense lesions, and persistent enhancement kinetics (P <0.05). In contrast, older patients more commonly showed irregular morphology, diffuse edema, T2 hypointensity, and increased skin thickness (P <0.05). In the young-onset cohort, rim enhancement was associated with HER2-positive tumors (P = 0.006), and heterogeneous enhancement was associated with diffuse edema (P = 0.002). An ADC threshold of <830 × 10⁻⁶ mm²/s predicted invasive carcinoma of no special type with 49.2% sensitivity and 80.0% specificity. In patients aged ≥50 years, rim enhancement was associated with triple-negative subtype (P = 0.006).

Conclusion

Breast cancer in women aged ≤40 years exhibits distinct MRI features compared with older patients. Findings such as circumscribed margins, T2 iso/hyperintensity, and persistent enhancement may still reflect aggressive tumor biology in young women.