title: Residual Mammographic Microcalcifications and Enhancing Lesions on MRI After Neoadjuvant Systemic Chemotherapy for Locally Advanced Breast Cancer: Correlation with Histopathologic Residual Tumor Size.
abstract: OBJECTIVE
  To evaluate the accuracy of residual microcalcifications on mammogram (MG) in predicting the extent of the residual tumor after neoadjuvant systemic treatment (NST) in patients with locally advanced breast cancer and to evaluate factors affecting the accuracy of MG microcalcifications using magnetic resonance imaging (MRI) as a reference.
  
  
  METHODS
  The patients who underwent NST and showed suspicious microcalcifications on MG comprised our study population. Clinicopathologic and imaging (MG, MRI) findings were investigated. Agreement between image findings and pathology was assessed and factors affecting the discrepancy were analyzed.
  
  
  RESULTS
  Among 207 patients, 196 had residual invasive ductal carcinoma or ductal carcinoma-in-situ (mean size, 3.78 cm). The overall agreement of residual microcalcifications on MG predicting residual tumor extents was lower than MRI in all tumor subtypes (intraclass correlation coefficient [ICC] = 0.368 and 0.723, p < 0.0001). The agreement of residual MG microcalcifications and pathology was highest in HR(+)/HER2(+) tumors and lowest in the triple-negative tumors (ICC = 0.417 and 0.205, respectively). Multivariate linear regression analysis revealed that a size discrepancy between microcalcifications and histopathology was correlated with molecular subtype (p = 0.005). In HR(+)/HER2(-) and triple-negative subtypes, the mean extents of residual microcalcification were smaller than residual cancer, and overestimation of tumor extent was more frequent in HR(+)/HER2(+) and HR(-)/HER2(+) tumors.
  
  
  CONCLUSIONS
  The extent of microcalcifications on MG after NST showed an overall lower correlation with the extent of the pathologic residual tumor than enhancing lesions on MRI. The accuracy of residual tumor evaluation after NST with MG and MRI is affected by their molecular subtype.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Young-Seon
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. imchangjm@gmail.com.
authors.forename: Jung Min
authors.initials: JM
authors.lastname: Chang
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyeong-Gon
authors.initials: HG
authors.lastname: Moon
authors.affiliation: Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Joongyub
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sung Ui
authors.initials: SU
authors.lastname: Shin
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Moon
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D002114:Calcinosis / Q000139:chemically induced / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000139:chemically induced / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone