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Residual Mammographic Microcalcifications and Enhancing Lesions on MRI After Neoadjuvant Systemic Chemotherapy for Locally Advanced Breast Cancer: Correlation with Histopathologic Residual Tumor Size

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the accuracy of residual microcalcifications on mammogram (MG) in predicting the extent of the residual tumor after neoadjuvant systemic treatment (NST) in patients with locally advanced breast cancer and to evaluate factors affecting the accuracy of MG microcalcifications using magnetic resonance imaging (MRI) as a reference.

Methods

The patients who underwent NST and showed suspicious microcalcifications on MG comprised our study population. Clinicopathologic and imaging (MG, MRI) findings were investigated. Agreement between image findings and pathology was assessed and factors affecting the discrepancy were analyzed.

Results

Among 207 patients, 196 had residual invasive ductal carcinoma or ductal carcinoma-in-situ (mean size, 3.78 cm). The overall agreement of residual microcalcifications on MG predicting residual tumor extents was lower than MRI in all tumor subtypes (intraclass correlation coefficient [ICC] = 0.368 and 0.723, p < 0.0001). The agreement of residual MG microcalcifications and pathology was highest in HR+/HER2+ tumors and lowest in the triple-negative tumors (ICC = 0.417 and 0.205, respectively). Multivariate linear regression analysis revealed that a size discrepancy between microcalcifications and histopathology was correlated with molecular subtype (p = 0.005). In HR+/HER2− and triple-negative subtypes, the mean extents of residual microcalcification were smaller than residual cancer, and overestimation of tumor extent was more frequent in HR+/HER2+ and HR−/HER2+ tumors.

Conclusions

The extent of microcalcifications on MG after NST showed an overall lower correlation with the extent of the pathologic residual tumor than enhancing lesions on MRI. The accuracy of residual tumor evaluation after NST with MG and MRI is affected by their molecular subtype.

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Acknowledgment

Supported in part by the Seoul National University Hospital Research Fund (Grant 04-2015-0740).

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

    Young-Seon Kim MD, Jung Min Chang MD, PhD, Sung Ui Shin MD & Woo Kyung Moon MD, PhD

  2. Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

    Hyeong-Gon Moon MD

  3. Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

    Joongyub Lee MD, PhD

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  1. Young-Seon Kim MD
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  2. Jung Min Chang MD, PhD
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Correspondence to Jung Min Chang MD, PhD.

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Kim, YS., Chang, J.M., Moon, HG. et al. Residual Mammographic Microcalcifications and Enhancing Lesions on MRI After Neoadjuvant Systemic Chemotherapy for Locally Advanced Breast Cancer: Correlation with Histopathologic Residual Tumor Size. Ann Surg Oncol 23, 1135–1142 (2016). https://doi.org/10.1245/s10434-015-4993-2

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  • DOI: https://doi.org/10.1245/s10434-015-4993-2

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