title: Calcifications on mammogram do not correlate with tumor size after neoadjuvant chemotherapy.
abstract: BACKGROUND
  Calcifications can be indicative of malignancy, but calcifications also can be a byproduct of necrotic tissue as cancer cells die. Current treatment regimens require excision of calcifications. The objective of this study was to examine the correlation between the extent of calcification on mammography and actual tumor size after neoadjuvant chemotherapy (NAC) as well as magnetic resonance imaging (MRI) for comparison.
  
  
  METHODS
  We retrospectively reviewed all patients at the University of California, San Diego, who underwent NAC for breast cancer between 2007 and 2013. Pearson correlation coefficients were computed between breast imaging and pathological measurements.
  
  
  RESULTS
  There were 136 patients total. Average age was 51 years. Fifty-three patients had calcifications on imaging (calc+); 83 did not (calc-). In the calc- group, extent of disease measured by mammogram (MMG) and MRI correlated moderately well with pathological tumor size (0.46 and 0.48, p = not significant). In the calc+ group, MRI was more likely to correlate with pathology than MMG (0.55 vs. -0.12, p = 0.01). Twenty-five calc+ patients had increased calcification after NAC; six of these had complete pathologic response. MRI correlated better with tumor size on pathology in patients with anti-HER2neu-based regimens than in patients with cytotoxic chemotherapy-alone regimens (0.88 vs. 0.4, p = 0.0001). MRI also is more accurate at predicting pathological tumor size in patients with triple negative disease (p = 0.002).
  
  
  CONCLUSIONS
  Magnetic resonance imaging correlated well while MMG calcification measurements correlated poorly with tumor size on final pathology. Extent of calcifications on diagnostic mammography may not be accurate in preoperative evaluation of breast cancers after NAC.
authors: Department of Surgery, University of California, San Diego, La Jolla, CA, USA.
authors: Anna
authors: A
authors: Weiss
authors: Katherine C
authors: KC
authors: Lee
authors: Yajahira
authors: Y
authors: Romero
authors: Erin
authors: E
authors: Ward
authors: Yeunjeong
authors: Y
authors: Kim
authors: Haydee
authors: H
authors: Ojeda-Fournier
authors: John
authors: J
authors: Einck
authors: Sarah L
authors: SL
authors: Blair
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D002114:Calcinosis / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies