Limits...
The role of mammographic calcification in the neoadjuvant therapy of breast cancer imaging evaluation.

Li JJ, Chen C, Gu Y, Di G, Wu J, Liu G, Shao Z - PLoS ONE (2014)

Bottom Line: No significant correlation was observed between the calcification appearance (morphology, distribution, range, diameter or density) and tumor subtypes or pCR rates.Calcification appearance did not clearly change after NACT, and calcification patterns were not related to pCR rate, suggesting that mammogram may not accurate to evaluate tumor response changes.Microcalcifications visible after NACT is essential for determining the extent of excision, patients with calcifications that occurred outside of the mass still had the opportunity for breast conservation.

View Article: PubMed Central - PubMed

Affiliation: Department of Breast Surgery, Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, China.

ABSTRACT

Introduction: Investigate the patterns of mammographically detected calcifications before and after neoadjuvant chemotherapy (NACT) to determine their value for efficacy evaluation and surgical decision making.

Methods: 187 patients with malignant mammographic calcifications were followed to record the appearances and changes in the calcifications and to analyze their responses to NACT.

Results: Patients with calcifications had higher rates of hormonal receptor (HR) positive tumors (74.3% versus 64.6%) and HER2 positive tumors (51.3% versus 33.4%, p = 0.004) and a similar pathologic complete response (pCR) rate compared to patients without calcifications (35.4% versus 29.8%). After NACT, the range of calcification decreased in 40% of patients, increased in 7.5% and remained stable in 52.5%; the calcification density decreased in 15% of patients, increased in 7.5% and remained stable in 77.5%; none of these change patterns were related to tumor response rate. No significant correlation was observed between the calcification appearance (morphology, distribution, range, diameter or density) and tumor subtypes or pCR rates. Among patients with malignant calcifications, 54 showed calcifications alone, 40 occurred with an architectural distortion (AD) and 93 with a mass. Calcifications were observed inside the tumor in 44% of patients and outside in 56%, with similar pCR rates and patterns of change.

Conclusions: Calcification appearance did not clearly change after NACT, and calcification patterns were not related to pCR rate, suggesting that mammogram may not accurate to evaluate tumor response changes. Microcalcifications visible after NACT is essential for determining the extent of excision, patients with calcifications that occurred outside of the mass still had the opportunity for breast conservation.

Show MeSH

Related in: MedlinePlus

Distribution of histological subtypes according to MG appearances.Cal: calcification; AD: architectural distortion; TN: triple negative; TP: triple positive. * Histological subtypes were achieved by core needle biopsy and MG before NACT were evaluated for calcification appearance.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3921249&req=5

pone-0088853-g001: Distribution of histological subtypes according to MG appearances.Cal: calcification; AD: architectural distortion; TN: triple negative; TP: triple positive. * Histological subtypes were achieved by core needle biopsy and MG before NACT were evaluated for calcification appearance.

Mentions: Overall, 732 consecutive patients were enrolled in this NACT trial. A total of 187 patients with MG calcifications with malignant appearances were eligible for assessment, accounting for one-quarter of all patients. Among this group, 6 patients did not have clear surgical records and 61 missed the MG after NACT. The control group consisted of 48 patients without calcifications with a malignant appearance. Among 187 patients, the mean primary tumor size was 3.39 cm, 18 patients were T1 diseases, 145 were T2, 22 were T3 and 2 were T4 (according to breast ultrasound and MRI evaluation before NACT), 145 patients showed clinical positive axillary lymph nodes (cN+). Figure 1 shows the distribution of histological subtypes (achieved by CNB) according to MG appearance before NACT. Among 187 patients with malignant calcifications, 54 had calcifications alone, 40 occurred with architectural distortion (AD) and 93 with mass in their images. The proportions of HR+HER2−, Triple Positive, HR−HER2+ and Triple Negative tumors were 43.3%, 31%, 20.3% and 5.4%, respectively, in patients with calcifications, indicating higher rates of HR positive tumors (74.3% versus 64.6%) and HER2 positive tumors (51.3% versus 33.4%), p = 0.004. The distribution of the histological subtypes in patients with only calcifications was similar to the distribution in those with mass or AD, p = 0.245. Patients with calcifications had a slightly higher pCR rate compared to those without calcifications, 35.4% versus 29.8%, but this difference was not statistically significant. Patients with calcifications only showed a statistically significantly higher rate of pCR compared to patients with mass or AD, 45.3% versus 31.3%, p = 0.072.


The role of mammographic calcification in the neoadjuvant therapy of breast cancer imaging evaluation.

Li JJ, Chen C, Gu Y, Di G, Wu J, Liu G, Shao Z - PLoS ONE (2014)

Distribution of histological subtypes according to MG appearances.Cal: calcification; AD: architectural distortion; TN: triple negative; TP: triple positive. * Histological subtypes were achieved by core needle biopsy and MG before NACT were evaluated for calcification appearance.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921249&req=5

pone-0088853-g001: Distribution of histological subtypes according to MG appearances.Cal: calcification; AD: architectural distortion; TN: triple negative; TP: triple positive. * Histological subtypes were achieved by core needle biopsy and MG before NACT were evaluated for calcification appearance.
Mentions: Overall, 732 consecutive patients were enrolled in this NACT trial. A total of 187 patients with MG calcifications with malignant appearances were eligible for assessment, accounting for one-quarter of all patients. Among this group, 6 patients did not have clear surgical records and 61 missed the MG after NACT. The control group consisted of 48 patients without calcifications with a malignant appearance. Among 187 patients, the mean primary tumor size was 3.39 cm, 18 patients were T1 diseases, 145 were T2, 22 were T3 and 2 were T4 (according to breast ultrasound and MRI evaluation before NACT), 145 patients showed clinical positive axillary lymph nodes (cN+). Figure 1 shows the distribution of histological subtypes (achieved by CNB) according to MG appearance before NACT. Among 187 patients with malignant calcifications, 54 had calcifications alone, 40 occurred with architectural distortion (AD) and 93 with mass in their images. The proportions of HR+HER2−, Triple Positive, HR−HER2+ and Triple Negative tumors were 43.3%, 31%, 20.3% and 5.4%, respectively, in patients with calcifications, indicating higher rates of HR positive tumors (74.3% versus 64.6%) and HER2 positive tumors (51.3% versus 33.4%), p = 0.004. The distribution of the histological subtypes in patients with only calcifications was similar to the distribution in those with mass or AD, p = 0.245. Patients with calcifications had a slightly higher pCR rate compared to those without calcifications, 35.4% versus 29.8%, but this difference was not statistically significant. Patients with calcifications only showed a statistically significantly higher rate of pCR compared to patients with mass or AD, 45.3% versus 31.3%, p = 0.072.

Bottom Line: No significant correlation was observed between the calcification appearance (morphology, distribution, range, diameter or density) and tumor subtypes or pCR rates.Calcification appearance did not clearly change after NACT, and calcification patterns were not related to pCR rate, suggesting that mammogram may not accurate to evaluate tumor response changes.Microcalcifications visible after NACT is essential for determining the extent of excision, patients with calcifications that occurred outside of the mass still had the opportunity for breast conservation.

View Article: PubMed Central - PubMed

Affiliation: Department of Breast Surgery, Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, China.

ABSTRACT

Introduction: Investigate the patterns of mammographically detected calcifications before and after neoadjuvant chemotherapy (NACT) to determine their value for efficacy evaluation and surgical decision making.

Methods: 187 patients with malignant mammographic calcifications were followed to record the appearances and changes in the calcifications and to analyze their responses to NACT.

Results: Patients with calcifications had higher rates of hormonal receptor (HR) positive tumors (74.3% versus 64.6%) and HER2 positive tumors (51.3% versus 33.4%, p = 0.004) and a similar pathologic complete response (pCR) rate compared to patients without calcifications (35.4% versus 29.8%). After NACT, the range of calcification decreased in 40% of patients, increased in 7.5% and remained stable in 52.5%; the calcification density decreased in 15% of patients, increased in 7.5% and remained stable in 77.5%; none of these change patterns were related to tumor response rate. No significant correlation was observed between the calcification appearance (morphology, distribution, range, diameter or density) and tumor subtypes or pCR rates. Among patients with malignant calcifications, 54 showed calcifications alone, 40 occurred with an architectural distortion (AD) and 93 with a mass. Calcifications were observed inside the tumor in 44% of patients and outside in 56%, with similar pCR rates and patterns of change.

Conclusions: Calcification appearance did not clearly change after NACT, and calcification patterns were not related to pCR rate, suggesting that mammogram may not accurate to evaluate tumor response changes. Microcalcifications visible after NACT is essential for determining the extent of excision, patients with calcifications that occurred outside of the mass still had the opportunity for breast conservation.

Show MeSH
Related in: MedlinePlus