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MRI prediction of neoadjuvant chemotherapy response is equivalent in patients with or without mammographic calcifications: a step towards adapting surgical approach?

  • Breast
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Abstract

Objectives

Current surgical policy recommends comprehensive excision of tumorous calcifications in breast cancer patients following neoadjuvant chemotherapy (NAC) regardless of MRI outcomes, despite MRI defining tumor response superior to mammography. The current study examines MRI prediction of response in tumors with vs without calcifications, using post-NAC surgical pathology as the standard of reference.

Methods

Retrospective analysis of 114 NAC patients between 2011 and 2018 including demographics, mammography, 3 T-MRI, and pathology compared two sub-groups: without (n = 62) or with (n = 52) mammographic calcifications. In the calcification cohort, the mammographic extent of calcifications and MRI enhancement overlapped. MRI prediction of response to NAC was correlated with pathology. Two-tailed paired T and Fisher’s exact tests and Cohen’s kappa coefficient were applied for analysis.

Results

There was no significant difference between the two sub-groups regarding demographics. Tumors demonstrated equivalent features regarding size, lymph node involvement, and DCIS component. ER-negative/HER2-positive tumors more commonly exhibited calcifications (33% n = 17 calcified vs 13% n = 8 non-calcified; p < 0.05); triple negative pathology rarely calcified (6% n = 3 calcified vs 33% n = 20 non-calcified; p < 0.05). NME was more common with calcifications (62% n = 32 calcified vs 29% n = 18 non-calcified; p < 0.05) and mass enhancement without (90% n = 56 non-calcified vs 81% n = 42 calcified; p < 0.05). Both groups responded similarly to NAC (pCR = 37% non-calcified vs 38% calcified); response on MRI equally correlated with pathology (69% both subgroups; p = 0.988).

Conclusion

We propose utilizing post-NAC MRI findings rather than mammography in planning surgery, as MRI prediction is independent of the presence or absence of calcifications. Prospective studies to evaluate this approach are warranted.

Key Points

• No difference was found in demographic, clinical, pathology, or imaging characteristics between patients with or without tumoral calcifications on mammography prior to neoadjuvant chemotherapy.

• Residual mammographic calcifications are inadequate predictors of residual invasive disease. MRI accurately recognized complete response and correctly correlated with post-treatment surgical pathology in 69% of patients, regardless of the presence or absence of mammographic calcifications.

• We propose utilizing post-NAC MRI findings rather than mammography in planning post-NAC surgery, as MRI prediction of response is independent of the presence or absence of calcifications.

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Abbreviations

BCS:

Breast-conserving surgery

DCIS:

Ductal carcinoma in situ

IDC:

Invasive ductal carcinoma

ILC:

Invasive lobular carcinoma

LABC:

Locally advanced breast cancer

MRI:

Magnetic resonance imaging

NAC:

Neoadjuvant chemotherapy

NME:

Non-mass enhancement

pCR:

Pathologic complete response

rCR:

Radiologic complete response

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Acknowledgements

This study was performed as an MD dissertation to fulfill requirements at the Hadassah Hebrew University Medical School. We would like to thank Ms Tali Bdolah-Abram from the Hadassah Hebrew University Medical School for her statistical consultation and guidance.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Tamar Sella and Bar Simor sh are equal contribution as first author.

Authors and Affiliations

  1. Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel

    Tamar Sella, Bar Simor & Yael Adler - Levy

  2. Hebrew University Medical School, Jerusalem, Israel

    Tamar Sella, Bar Simor, Yael Adler - Levy, Bella Maly & Luna Kadouri

  3. Department of Pediatrics, Haim Sheba Medical Center, Ramat Gan, Israel

    Bar Simor

  4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Bar Simor

  5. Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel

    Bella Maly

  6. Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel

    Luna Kadouri

  7. Department of Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel

    Einat Carmon

  8. Ben Gurion University Medical School, Beer Sheva, Israel

    Einat Carmon

Authors
  1. Tamar Sella
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Corresponding author

Correspondence to Tamar Sella.

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Guarantor

The scientific guarantor of this publication is Tamar Sella.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

We would like to thank Ms Tali Bdolah-Abram from the Hadassah Hebrew University Medical School for her statistical consultation and guidance.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (Hadassah Hebrew University Medical Center Institutional Review Board, ref. 0299–18-HMO).

Study subjects or cohorts overlap

No overlap in study subjects or cohorts.

Methodology

• retrospective

• observational

• performed at one institution

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Sella, T., Simor, B., Adler - Levy, Y. et al. MRI prediction of neoadjuvant chemotherapy response is equivalent in patients with or without mammographic calcifications: a step towards adapting surgical approach?. Eur Radiol 33, 7168–7177 (2023). https://doi.org/10.1007/s00330-023-09640-x

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