Histopathological Characteristics of Triple-Negative Breast Cancer: An Iranian Issue

  • Mehrnoosh Etemadi Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran
  • Mohammad Mahdi Zamani Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran
  • Amir Masoud Nazemi Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Iranian Blood Transfusion Organization, Tehran
  • Afsaneh Rajabiani Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran
  • Alireza Abdollahi Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran
Keywords: , Breast cancer, Epidemiology, Iran, Hormone receptor, Triple-negative breast cancer


Background: Breast cancer is one of the most frequent malignancies among Iranian women. Triple-negative breast cancer (TNBC) is referred to a type of breast cancer which three biomarkers of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2), are negative.Materials and Methods: In this case control study, immunohistopathologic data of patients with TNBC were compared with non-TNBC patients. According to pathological reports, frequency, age, gender, type, size, and tumor grade, involvement and the number of involved lymph nodes, mitosis, Ki-67, necrosis, nuclear grade, tumor side, involvement of the margins, skin involvement, nipple involvement, tumor location, vascular invasion, perineural invasion, presence of in-situ compartment and the benign accompanied tumors, granulomatosis reaction, and calcification were compared between both groups.Results: Two hundred fourteen pathological samples of patients with breast cancer were evaluated. TNBC was seen in about 14% of breast cancers in this study on Iranian population. The mean age of TNBC group was 43±12 years and non-TNBC was 50±12 years (p=0.03). TNBC had significantly higher grade, high mitotic indices, more possibility of P53 positivity and higher level of Ki-67. Presence of vascular and nerve invasion and involvement of the margins at the time of diagnosis were seen in the TNBC group comparing with the non-TNBC group.Conclusion: Younger age, higher grading, neurovascular invasion, P53 positivity, and high levels of Ki-67, lead clinicians to evaluate the biomarkers of TNBC, and in case of confirming TNBC diagnosis, appropriate treatment methods should be added to the routine ones in breast cancer.

Author Biography

Mohammad Mahdi Zamani, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran
Resident of Anesthesiology, Department of Anesthesiology, Firoozgar Hospital, Tehran University of Medical Sciences


Muñoz M, Estévez LG, Alvarez I, Fernández Y, Margelí M, Tusquets I, et al. Evaluation of international treatment guidelines and prognostic tests for the treatment of early breast cancer. Cancer Treat Rev. 2008;34(8):701-9.

Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277-300.

Mousavi SM, Montazeri A, Mohagheghi MA, Jarrahi AM, Harirchi I, Najafi M, et al. Breast cancer in Iran: an epidemiological review. Breast J. 2007;13(4):383-91.

Abd El‐Rehim DM, Pinder SE, Paish CE, Bell J, Blamey R, Robertson JF, et al. Expression of luminal and basal cytokeratins in human breast carcinoma. J Pathol. 2004;203(2):661-71.

Rubovszky G, Udvarhelyi N, Horváth Z, Láng I, Kásler M. Triple-negative breast carcinoma--rewiev of current literature]. Magyar onkologia. 2010;54(4):325.

Morris GJ, Naidu S, Topham AK, Guiles F, Xu Y, McCue P, et al. Differences in breast carcinoma characteristics in newly diagnosed African–American and Caucasian patients. Cancer. 2007;110(4):876-84.

Lehmann BD, Bauer JA, Chen X, Sanders ME, Chakravarthy AB, Shyr Y, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest. 2011;121(7):2750.

Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007;13(15):4429-34.

Liedtke C, Mazouni C, Hess KR, André F, Tordai A, Mejia JA, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2008;26(8):1275-81.

Lin NU, Claus E, Sohl J, Razzak AR, Arnaout A, Winer EP. Sites of distant recurrence and clinical outcomes in patients with metastatic triple‐negative breast cancer. Cancer. 2008;113(10):2638-45.

Anders CK, Deal AM, Miller CR, Khorram C, Meng H, Burrows E, et al. The prognostic contribution of clinical breast cancer subtype, age, and race among patients with breast cancer brain metastases. Cancer. 2011;117(8):1602-11.

Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer. N Engl J Med. 2010;363(20):1938-48.

De Laurentiis M, Cianniello D, Caputo R, Stanzione B, Arpino G, Cinieri S, et al. Treatment of triple negative breast cancer (TNBC): current options and future perspectives. Cancer Treat Rev. 2010;36:S80-S6.

Santana-Davila R, Perez EA. Treatment options for patients with triple-negative breast cancer. J Hematol Oncol. 2010;3:42.

Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F, et al. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res. 2007;13(8):2329-34.

Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)‐negative, progesterone receptor (PR)‐negative, and HER2‐negative invasive breast cancer, the so‐called triple‐negative phenotype. Cancer. 2007;109(9):1721-8.

Haffty BG, Yang Q, Reiss M, Kearney T, Higgins SA, Weidhaas J, et al. Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol. 2006;24(36):5652-7.

Tischkowitz M, Brunet J-S, Bégin LR, Huntsman DG, Cheang MC, Akslen LA, et al. Use of immunohistochemical markers can refine prognosis in triple negative breast cancer. BMC cancer. 2007;7(1):134.

Rakha EA, El‐Sayed ME, Green AR, Lee AH, Robertson JF, Ellis IO. Prognostic markers in triple‐negative breast cancer. Cancer. 2007;109(1):25-32.

Suresh P, Batra U, Doval D. Epidemiological and clinical profile of triple negative breast cancer at a cancer hospital in North India. Indian J Med Paediatr Oncol. 2013;34(2):89.

Amirikia KC, Mills P, Bush J, Newman LA. Higher population‐based incidence rates of triple‐negative breast cancer among young African‐American women. Cancer. 2011;117(12):2747-53.

Boyle P. Triple-negative breast cancer: epidemiological considerations and recommendations. Ann Oncol. 2012;23(suppl 6):vi7-vi12.

How to Cite
Etemadi, M., Zamani, M. M., Nazemi, A. M., Rajabiani, A., & Abdollahi, A. (2014). Histopathological Characteristics of Triple-Negative Breast Cancer: An Iranian Issue. Galen Medical Journal, 3(3), 145-52. https://doi.org/10.31661/gmj.v3i3.146
Original Article