Calcifications on Mammogram Do Not Correlate with Tumor Size After Neoadjuvant Chemotherapy

Weiss, Anna; Lee, Katherine C.; Romero, Yajahira; Ward, Erin; Kim, Yeunjeong; Ojeda‐Fournier, Haydee; Einck, John; Blair, Sarah L.

doi:10.1245/s10434-014-3914-0

Cited by 53 publications

(27 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although Weiss et al reported that in 53 patients with cancers containing calcifications who received NAC, MRI had a higher correlation with pathologic tumor size than mammography, malignant-appearing calcifications associated with viable tumor and those associated with necrotic tumor cannot be reliably distinguished at this time, and mammography and MRI are complementary studies in determining the appropriate extent of surgical resection after NAC. 19 …”

Section: Discussionmentioning

confidence: 99%

Do MRI and Mammography Reliably Identify Candidates for Breast Conservation After Neoadjuvant Chemotherapy?

et al. 2015

View full text Add to dashboard Cite

Background Neoadjuvant chemotherapy (NAC) may allow breast-conserving therapy (BCT) in patients who require mastectomy at presentation. Breast MRI is more accurate than mammography in assessing treatment response, but combined test reliability in identifying BCT candidates after NAC is not well described. We evaluated whether post-NAC breast MRI alone and with mammography accurately identifies BCT candidates. Methods In this retrospective study of 111 consecutive breast cancer patients receiving NAC, all had pre- and postchemotherapy MRI, followed by surgery. Posttreatment MRI and mammography results were correlated with surgical outcomes and pathologic response. Results Fifty-one of 111 (46 %) patients presented with multicentric or inflammatory breast cancer and were not BCT candidates. The remaining 60 (54 %) were considered BCT candidates after downstaging (mean age: 47 years). All 60 had at least a partial response to NAC and were suitable for BCT on MRI after NAC. Forty-five of 60 (75 %) underwent lumpectomy; 15 of 60 (25 %) chose mastectomy. Forty-one of 45 (91 %) of lumpectomies were successful; 4 of 45 (9 %) required mastectomy. Twelve of 15 (80 %) patients choosing mastectomy could have undergone BCT based on pathology; 3 of 15 (20 %) did require mastectomy. Two of these three patients had extensive microcalcifications on mammogram, indicating the need for mastectomy despite MRI suitability for BCS. MRI alone correctly predicted BCS in 53 of 60 (88 %) patients. MRI plus mammography was correct in 55 of 60 (92 %), although only 9 of 45 (20 %) BCT patients and 4 of 15 (27 %) potentially conservable mastectomy patients had complete pathologic responses. Conclusions Posttreatment MRI plus mammography is an accurate method to determine whether BCT is possible after NAC is given to downstage disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Do MRI and Mammography Reliably Identify Candidates for Breast Conservation After Neoadjuvant Chemotherapy?

et al. 2015

View full text Add to dashboard Cite

show abstract

“…33 In aggregate, the literature indicates that MRI is useful for selecting patients who are candidates for BCS after NACT. In patients with malignant calcifications, a post-NACT mammogram is also useful for planning the extent of the resection: although calcifications do not always indicate residual malignancy, 34 the presence of residual disease cannot be reliably excluded unless all radiographic abnormalities are removed.…”

Section: Patient Selection For Nact To Enable Bcsmentioning

confidence: 99%

Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy

2015

View full text Add to dashboard Cite

Early randomized trials of the addition of neoadjuvant chemotherapy (NACT) to the treatment regimen of patients with breast cancer failed to demonstrate an improvement in overall survival compared with conventional adjuvant therapy; nevertheless, the increased opportunities for breast conservation, owing to downstaging of the primary tumour, and enthusiasm regarding the potential to tailor systemic therapy based on responses observed in the neoadjuvant setting, resulted in the adoption of this approach as a useful clinical tool. That the effectiveness of NACT varies by molecular subtype is becoming increasingly clear, and although the potential of tailoring adjuvant systemic therapy based on treatment response before surgery remains to be realized, the increasing rates of pathological complete response following NACT have had a considerable impact on locoregional treatment considerations. For example, NACT reduces the need for mastectomy and axillary lymph-node dissection, thus decreasing the morbidity of surgery, without compromising outcomes. However, selection of the ideal candidates for preoperative chemotherapy remains critical, and personalizing local therapy based on the degree of response is the subject of ongoing clinical trials. This article reviews the current issues surrounding surgery of the breast and axilla in patients with breast cancer receiving NACT.

show abstract

“…While the meta-analysis also demonstrated that mammography had lower accuracy for detection of residual disease than MRI (P = 0.02) (128), in patients with malignant calcifications, a post-NACT mammogram is also indicated. Although calcifications do not always indicate residual malignancy(134), the presence of residual disease cannot be reliably excluded unless all radiographic abnormalities are removed.…”

Section: Surgical Considerations In Patients Receiving Preoperative Cmentioning

confidence: 99%

Trends and controversies in multidisciplinary care of the patient with breast cancer

Dominici

Morrow

Mittendorf

et al. 2016

Current Problems in Surgery

View full text Add to dashboard Cite

Calcifications on Mammogram Do Not Correlate with Tumor Size After Neoadjuvant Chemotherapy

Abstract: Magnetic resonance imaging correlated well while MMG calcification measurements correlated poorly with tumor size on final pathology. Extent of calcifications on diagnostic mammography may not be accurate in preoperative evaluation of breast cancers after NAC.

Cited by 53 publications

References 35 publications

Do MRI and Mammography Reliably Identify Candidates for Breast Conservation After Neoadjuvant Chemotherapy?

Do MRI and Mammography Reliably Identify Candidates for Breast Conservation After Neoadjuvant Chemotherapy?

Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy

Trends and controversies in multidisciplinary care of the patient with breast cancer

Contact Info

Product

Resources

About