Human Epidermal Growth Factor 2–positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy

Abstract

Purpose To determine the relationship between the presence or absence of mammographic calcifications in human epidermal growth factor receptor 2 (HER2)-positive breast cancers and pathologic complete response (pCR) to neoadjuvant chemotherapy and to determine other tumor and clinical characteristics that may be predictive of such a response. Materials and Methods A database of all patients with HER2-positive breast cancer who underwent neoadjuvant chemotherapy between 2007 and 2015 was retrospectively reviewed. Patient demographic characteristics, mammographic appearance, molecular subtype of cancer (luminal or nonluminal), radiologic response (based on breast magnetic resonance images), surgery, and pathologic response to treatment were recorded. Inter- and subgroup comparison was performed for presence of mammographic microcalcification and cancer subtype by using Mann-Whitney and χ tests and logistic regression. Results A total of 111 patients with a median age of 49 years (interquartile range, 40-57 years) were evaluated. Of these, 64.9% (72 of 111) had mammographic microcalcifications, 63.1% (70 of 111) had luminal B cancer, and 36.9% (41 of 111) had nonluminal HER2-positive cancer. Radiologic response to neoadjuvant chemotherapy was observed in 70.3% (78 of 111) of patients. Surgery was performed in 97.3% (108 of 111) of patients, and 30.6% (34 of 111) of patients underwent breast conservation. pCR was observed in 33.3% (37 of 111) of patients; 16.2% (18 of 111) showed residual ductal carcinoma in situ and 50.5% (56 of 111) had residual invasive disease. The pCR rate was the same (P = .21) in patients with mammographic microcalcification (29.2% [21 of 72]) as in those without calcification (41.0% [16 of 39]). The pCR rate in patients with nonluminal HER2-positive cancers (46.3% [19 of 41]) was higher (P = .01) than in those with luminal B cancers (25.7% [18 of 70]). pCR was associated with nonluminal HER2-positive subtype (odds ratio, 5.4; 95% confidence interval: 1.8, 16.0; P = .01) and complete radiologic response (odds ratio, 20.4; 95% confidence interval: 3.3, 126.6; P = .01). Conclusion Patients with HER2-positive cancer and mammographic microcalcification can achieve pCR after neoadjuvant chemotherapy. Nonluminal HER2-positive subtype and complete radiologic response are predictors of pCR.

Analysis of the molecular subtypes of preoperative core needle biopsy and surgical specimens in invasive breast cancer

“…Sometimes when scattered calcification was noted, ultrasound-guided mammotome biopsy was performed with an 11-gauge needle, and > 12 core passes were obtained. It has been reported that radiologically recognized calcifications in breast cancer are associated with HER2 molecular subtype and pCR after neoadjuvant chemotherapy [30,31]. Another reason for collection of multiple cores in CNB is to overcome tumor heterogeneity.…”

Imaging and Clinicopathologic Features Associated With Pathologic Complete Response in HER2-positive Breast Cancer Receiving Neoadjuvant Chemotherapy With Dual HER2 Blockade

“…Mazari et al reported that the pCR rate in patients with mammographic microcalcification of HER2 þ breast cancer was not different to that in those without calcification. 17 Li et al also reported that patients with calcification had a similar pCR rate to patients without calcifications. 18 These results are in accord with the findings of this study, with 72.0% of the pCR group and 59.1% of the non-pCR group showing calcifications on mammography.…”

Prediction of treatment responses to neoadjuvant chemotherapy in breast cancer using contrast-enhanced ultrasound

“…This might contribute to different chemosensitivities among molecular subtypes. Mazari et al (31) reported that the HER2+ subtype is a significant predictor for pathologically complete responses, and that the odds ratios increased from 2.49 to 5.4 when univariate regression analysis was changed to multivariate regression modeling. In concordance with previous studies (3,32), our results showed that triple-negative [odds ratio (OR): 2.872, 95% confidence interval (CI): 0.947-16.372] and HER2+ (OR: 3.939, 95% CI: 0.947-16.372) tumors exhibited better responses than hormone receptor-positive, HER2-breast cancer.…”