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Triple Negative Breast Carcinoma and the Basal Phenotype: From Expression Profiling to Clinical Practice

Diaz, Leslie K. MD*; Cryns, Vincent L. MD; Symmans, W. Fraser MD; Sneige, Nour MD

Advances in Anatomic Pathology: November 2007 - Volume 14 - Issue 6 - p 419-430
doi: 10.1097/PAP.0b013e3181594733
Review Articles

Triple negative breast carcinomas (TNBCs) are a group of primary breast tumors with aggressive clinical behavior. Most TNBCs possess a basal phenotype (BP) and show varying degrees of basal cytokeratin and myoepithelial marker expression. The importance of recognizing these tumors came to light largely as the result of gene expression profiling studies that categorized breast cancer into 3 major groups. Two of these groups are defined by their respective expression of estrogen receptor and HER2. TNBCs represent a third group and are defined by negativity for hormone receptors and HER2. TNBCs currently lack effective targeted therapies and are frequently resistant to standard chemotherapeutic regimens. These tumors tend to occur in premenopausal women and members of specific ethnic groups and a subset are associated with heritable BRCA1 mutations. For patients with sporadic TNBCs and BP tumors, BRCA1 dysfunction seems to play a major role in the development and progression of disease. The pathologist's role in the diagnosis and characterization of TNBCs and BP tumors is currently being defined as we are acquiring knowledge of the biologic and genetic underpinnings that drive this heterogeneous group of diseases. This review will provide a historical prospective on TNBCs and tumors that express basal cytokeratins and myoepithelial makers. Additionally, we will discuss the molecular biologic, genetic and pathologic aspects of these tumors. Guidelines will be provided on how to best approach the diagnosis of these cases and on what input pathologists should provide clinicians to help develop optimal therapeutic and preventative strategies against this aggressive group of breast cancers.

*Piper Breast Center, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, Minneapolis, MN

Cell Death Regulation Laboratory, Departments of Medicine and Cell and Molecular Biology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL

Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX

Reprints: Leslie K. Diaz, MD, Abbott Northwestern Hospital Laboratory, Internal Zip 11136, 800 E. 28th St., Minneapolis, MN 55407 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.