Change in microcalcifications on mammography after neoadjuvant chemotherapy in breast cancer patients: correlation with tumor response grade and comparison with lesion extent

Abstract

Background After neoadjuvant chemotherapy (NAC), persistent microcalcifications are often observed in spite of a decrease in the primary tumor size. Purpose To analyze the changes in microcalcifications after NAC and to evaluate the accuracy of residual microcalcifications in predicting the extent of residual cancer. Material and Methods Eighty patients who received NAC and underwent both mammography and magnetic resonance imaging (MRI) before and after the completion of NAC were included. The location of microcalcifications was classified into two types: inside the mass and outside the mass. Results The extent of the residual calcifications was larger than the pathologic residual lesion in 14 (74%) of 19 patients with complete response (CR) on MRI, but the discrepancy was <1 cm in eight (42%) patients. The median value of the discrepancy was significantly higher in patients showing CR with outside calcifications compared to CR with inside calcifications (2.0 cm vs. 0.7 cm, P = 0.008). After NAC, the decrease of calcifications was more frequently observed in cancers showing CR on MRI or Miller-Payne grade 5 and the increase of calcifications more frequently occurred in cancers showing progress disease on MRI or Miller-Payne grade 1 ( P < 0.001 and P = 0.044). Conclusion The change in microcalcifications after NAC was correlated with the tumor response to NAC. The discrepancy was highest in the group showing CR on MRI with outside calcifications. In tumors with inside calcifications, the discrepancy was relatively low within an acceptable range.

Oncologic necessity for the complete removal of residual microcalcifications after neoadjuvant chemotherapy for breast cancer

“…Although the size of the main tumor is reduced by NAC, it is difficult to reduce the final extent of surgery if diffuse microcalcifications remain or the tumors show a scattered shrinkage pattern 14 , 17 , 28 , 29 . Several studies have explored whether microcalcifications are related to tumor responses to NAC for breast cancer 16 , 17 , 30 , 31 . However, they have reported inconsistent conclusions, and the results were not significantly related to those differing based on subtypes or those that were related.…”

“…Even if the tumor size is reduced by NAC, performing breast-conserving surgery or reducing the surgical scale can be especially difficult when diffuse microcalcifications remain after NAC. Many studies have reported that the complete removal of residual microcalcifications after NAC for breast cancer appears to be safe [14][15][16][17] . However, malignant microcalcifications containing larger hydroxyapatite particles, even if detected as an early finding in breast cancer, are associated with more invasive breast carcinomas 18 .…”

Predicting the response to Neoadjuvant Chemotherapy. Can the addition of tomosynthesis improve the accuracy of CESM? A comparison with breast MRI

“…20 Furthermore, it is accepted that the presence of residual mammographic microcalcifications is not consistently related to residual disease, and that even with loss of MRI enhancement it is not possible to predict absence of residual disease with sufficient accuracy to avoid complete excision of tumour bed calcifications. 21-23 We suggest that this finding is also true for persistent microcalcifications in the absence of CESM enhancement.…”

Gastric cancer with calcifications: A case report

“…Burkill et al [ 22 ] reported that patients with noncalcified ovarian cancers survive longer than the patients with calcified tumors. However, in breast cancer, patients with decreased numbers of calcifications after neoadjuvant treatment had higher rates of complete pathological response compared with patients with no changes in calcification[ 23 , 24 ]. However, whether the degree of calcification is related to the response to chemotherapy and outcome remains unclear.…”