Value of mammographic microcalcifications and MRI-enhanced lesions in the evaluation of residual disease after neoadjuvant therapy for breast cancer

Chao Zhu; Minglei Chen; Yulin Liu; Pinxiong Li; Weitao Ye; Huifen Ye; Yunrui Ye; Zaiyi Liu; Changhong Liang; Chunling Liu

doi:10.21037/qims-22-1170

Value of mammographic microcalcifications and MRI-enhanced lesions in the evaluation of residual disease after neoadjuvant therapy for breast cancer

Quant Imaging Med Surg. 2023 Sep 1;13(9):5593-5604. doi: 10.21037/qims-22-1170. Epub 2023 Aug 11.

Authors

Chao Zhu^#^{1

2

3}, Minglei Chen^#^{1

2

4}, Yulin Liu^#^{1

2}, Pinxiong Li^{1

2}, Weitao Ye^{1

2}, Huifen Ye^{1

2}, Yunrui Ye^{1

2}, Zaiyi Liu^{1

2}, Changhong Liang^#^{1

2}, Chunling Liu^#^{1

2}

Affiliations

¹ Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
² Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
³ Department of Radiology, Ningyuan County People's Hospital, Yongzhou, China.
⁴ Shantou University Medical College, Shantou, China.

^# Contributed equally.

Abstract

Background: Microcalcifications persist even if a patient with breast cancer achieves pathologic complete response (pCR) as confirmed by surgery after neoadjuvant treatment (NAT). In practice, surgeons tend to remove all the microcalcifications. This study aimed to explore the correlation between changes in the extent of microcalcification after NAT and pathological tumor response and compare the accuracy of mammography (MG) and magnetic resonance imaging (MRI) in predicting the size of residual tumors.

Methods: This was a retrospective study which included a consecutive series of patients in Guangdong Provincial People's Hospital. Between January 2010 and January 2020, 127 patients with breast cancer and Breast Imaging Reporting and Data System (BI-RADS) 4-5 microcalcifications were included in this study. The maximum diameter of the microcalcifications on MG and lesion enhancement on MRI pre- and post-NAT were measured. The correlations between the changes in residual microcalcifications on MG and pCR were analyzed. Intraclass correlation coefficients (ICCs) were computed between the extent of the residual microcalcifications, residual enhancement, and residual tumor size.

Results: There were no statistically significant differences in the changes in microcalcifications after NAT according to the RECIST criteria on MRI (P=0.09) and Miller-Payne grade (P=0.14). MRI showed a higher agreement than did residual microcalcifications on MG in predicting residual tumor size (ICC: 0.771 vs. 0.097).

Conclusions: MRI is more accurate for evaluating residual tumor size in breast cancer. In our study, the extent of microcalcifications on MG after NAT had nearly no correlation with the pathological size of the residual tumor. Therefore, residual tumors with microcalcifications may not necessarily be a contraindication to breast-conserving surgery.

Keywords: Breast neoplasms; magnetic resonance imaging (MRI); mammography (MG); microcalcifications; neoadjuvant therapy.