Comparing Accuracy of Mammography and Magnetic Resonance Imaging for Residual Calcified Lesions in Breast Cancer Patients Undergoing Neoadjuvant Systemic Therapy

In breast cancer, the extent of the malignant-looking calcification usually does not decrease after neoadjuvant systemic treatment, making it difficult to know the extent of the tumor in surgical planning. Comparing different imaging tools for such cases, magnetic resonance imaging was shown to be more precise in predicting residual cancer, especially in the hormone receptor-negative subtype. Background: Neoadjuvant systemic therapy (NST) is performed to increase the rate of breast-conserving surgery in advanced breast cancer patients. Although magnetic resonance imaging (MRI) is accurate in predicting residual cancer, if calcification remains, the issue of whether to perform the surgery on the basis of the residual tumor prediction range in mammography (MMG) or MRI has not yet been elucidated. This study aimed to estimate the accuracy of predicting residual tumor after NST for residual microcalcification on mammographic and enhancing lesion on MRI. Patients and Methods: This was a single-center, retrospective study. We included breast cancer patients who underwent NST, had microcalcifications in the post-NST MMG, and underwent surgery from January 2, 2013 to December 30, 2014 at Asan Medical Center. Patients with post-NST MMG as well as MRI were included. Final pathologic tumor size with histopathology and biomarker status were obtained postoperatively. Results: In total, 151 patients were included in this study. Overall, MRI correlated better than MMG in predicting the tumor size (intraclass correlation coefficient [ICC], 0.769 vs. 0.651). For hormone receptor (HR)-positive (HR+)/HER2(-) subtype, MMG had higher correlation than MRI (ICC = 0.747 vs. 0.575). In HR- subtype, MRI had a strong correlation with pathology (HR-/HER2(+) or triple negative (TN), ICC = 0.939 vs. 0.750), whereas MMG tended to overestimate the tumor size (HR-/HER2(+) or TN, ICC = 0.543 vs. 0.479). Conclusion: Post-NST residual microcalcifications on MMG have a lower correlation with residual tumor size than MRI. Other than HR+/HER2(-) subtype, the extent of calcifications on preoperative evaluation might not be accurate in evaluating the residual extent of the tumor after NST. (C) 2018 Elsevier Inc. All rights reserved.